Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate - Université de Rennes Accéder directement au contenu
Article Dans Une Revue Journal of the American College of Cardiology Année : 2017

Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

Sérgio Barra
Rui Providência
Nicolas Sadoul
  • Fonction : Auteur
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Rudolf Duehmke
  • Fonction : Auteur
Christian Reitan
  • Fonction : Auteur
Rasmus Borgquist
  • Fonction : Auteur
Pascal Defaye
Jean-Sébastien Hermida
  • Fonction : Auteur
Khang-Li Looi
  • Fonction : Auteur
Anthony Chow
  • Fonction : Auteur
Munmohan Virdee
  • Fonction : Auteur
Simon Fynn
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Eloi Marijon
Sharad Agarwal
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  • PersonId : 962618

Résumé

Background: Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT).Objectives: The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure.Methods: This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes.Results: After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT without a defibrillator (hazard ratio for mortality adjusted on propensity score and all mortality predictors: 0.76; 95% confidence interval [CI]: 0.62 to 0.92; p = 0.005), whereas in patients with DCM, no such difference was observed (hazard ratio: 0.92; 95% CI: 0.73 to 1.16; p = 0.49). Compared with recipients of defibrillators, the excess mortality in patients who did not receive defibrillators was related to sudden cardiac death in 8.0% among those with ICM but in only 0.4% of those with DCM.Conclusions: Among patients with heart failure with indications for CRT, those with DCM may not benefit from additional primary prevention implantable cardioverter-defibrillator therapy, as opposed to those with ICM.

Dates et versions

hal-01760747 , version 1 (22-05-2018)

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Citer

Sérgio Barra, Serge Boveda, Rui Providência, Nicolas Sadoul, Rudolf Duehmke, et al.. Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate. Journal of the American College of Cardiology, 2017, 69 (13), pp.1669 - 1678. ⟨10.1016/j.jacc.2017.01.042⟩. ⟨hal-01760747⟩
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