Does defibrillation testing influence outcomes after CRT-D implantation? A cause-of-death analysis from the DAI-PP study - Université de Rennes Access content directly
Journal Articles International Journal of Cardiology Year : 2016

Does defibrillation testing influence outcomes after CRT-D implantation? A cause-of-death analysis from the DAI-PP study

Tilman Perrin
Alexis Mechulan
  • Function : Author
Pascal Defaye
Olivier Piot
Pierre Bordachar
  • Function : Author
Eloi Marijon
Jean-Claude Deharo

Abstract

Background: Little data address the usefulness of defibrillation testing in patients with prolonged QRS duration, known for more advanced myocardial disease. We aimed to compare baseline characteristics and outcomes between patients who underwent defibrillation testing (DT+) and those who did not (DT-), immediately after the implantation of a cardiac resynchronization therapy with defibrillator (CRT-D). Methods: Data from all patients with ischemic or non-ischemic cardiomyopathy implanted in primary prevention with a CRT-D in 12 French centers were considered for analysis (2002-2012). Results: Out of the 1516 patients with DT information available, DT was performed in 958(63%) patients. Compared to DT- patients, DT+ patients presented no significant differences in terms of age (65.1 +/- 10.8 vs 64.7 +/- 10.3 years, p = 0.45), LVEF (25%[20.0-30.0] vs 25%[20.5-30.0], p = 0.30), or etiologies of heart failure (ischemic: 49.6% vs 46.9%, p - 0.32). By contrast, DT+ patients were less likely to present atrial fibrillation (25.3% vs 33.4%, p = 0.001), renal insufficiency (eGFR < 60 ml/min in 45.3% vs 51.7%, p = 0.04) and NYHA functional class >= III (68.9% vs 77.4%, p = 0.0006). All of the three perioperative deaths occurred in the DT+ group and were related to DT itself. After a mean follow-up of 3.1 +/- 2.1 years, the adjusted incidence of overall mortality was lower among DT+ patients (adjusted HR 0.6, 95%CI 0.4-0.7, p < 0.0001). However, ICD-unresponsive sudden deaths remained very rare and no more frequently observed among DT- patients (p = 0.41). Conclusions: In our cohort, the higher (up to 40%) mortality at midterm among DT- patients is mainly reflecting their more severe cardiac disease, rather than a higher rate of ICD-unresponsive sudden death. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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hal-01414470 , version 1 (12-12-2016)

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Tilman Perrin, Alexis Mechulan, Serge Boveda, Frankie Beganton, Pascal Defaye, et al.. Does defibrillation testing influence outcomes after CRT-D implantation? A cause-of-death analysis from the DAI-PP study. International Journal of Cardiology, 2016, 221, pp.951--956. ⟨10.1016/j.ijcard.2016.06.189⟩. ⟨hal-01414470⟩
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