Journal of Arrhythmia (Dec 2022)

Ventricular arrhythmia events in heart failure patients with cardiac resynchronization therapy with or without a defibrillator for primary prevention

  • Toshihiro Nakamura,
  • Koji Fukuzawa,
  • Kunihiko Kiuchi,
  • Mitsuru Takami,
  • Yusuke Sonoda,
  • Hiroyuki Takahara,
  • Kazutaka Nakasone,
  • Kyoko Yamamoto,
  • Yuya Suzuki,
  • Ken‐ichi Tani,
  • Hidehiro Iwai,
  • Yusuke Nakanishi,
  • Mitsuhiko Shoda,
  • Atsushi Murakami,
  • Shogo Yonehara,
  • Ken‐ichi Hirata

DOI
https://doi.org/10.1002/joa3.12795
Journal volume & issue
Vol. 38, no. 6
pp. 1056 – 1062

Abstract

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Abstract Background It is uncertain whether cardiac resynchronization therapy with a defibrillator (CRT‐D) provides better survival benefits than a CRT‐pacemaker (CRT‐P) in heart failure patients with a reduced ejection fraction (≦35%, HFrEF) treated with contemporary HF therapy. Methods We retrospectively analyzed the ventricular arrhythmia (VAs; sustained ventricular tachycardia/fibrillation) events in HFrEF patients who underwent CRT without a prior history of VAs or aborted sudden cardiac death before the CRT implantation. Between January/2010 and December/2020, a CRT device was implanted in 79 HFrEF patients (mean age: 69 ± 12 years, male: 57, ischemic cardiomyopathy: 16). CRT‐D and CRT‐P devices were implanted in 50 and 29 patients, respectively, at each physician's discretion. CRT‐Ds were indicated in younger patients than were CRT‐Ps (66 ± 12 vs. 73 ± 12 years, p = 0.03), but the gender distribution did not differ (female, 24% [12 of 50] vs. 35% [10 of 29], p = 0.44). The VA events during a median follow‐up of 3.5‐years (interquartile range [IQR]:1.6–5.5) and their predictors were analyzed. Results VA events occurred in 9 patients with CRT‐Ds (18%) and one with a CRT‐P (3%, p = 0.08). The VA event rate was significantly lower in patients without a prior non‐sustained ventricular tachycardia (NSVT: ≥3 beats; rate, ≥120 bpm; lasting <30 s, HR 0.05; 95% CI 0.01–0.30; p < 0.01) and females (HR 0.11; 95% CI 0.01–0.93; p = 0.04). Of note, no female patients without a prior history of NSVT experienced VA events. Conclusion HFrEF CRT candidates without a prior history of NSVT and females may obtain less benefit from a primary preventive defibrillator indication.

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