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Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients.

Abstract：

AIMS:The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D). METHODS AND RESULTS:A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10-42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3-45.5] and 97.2 (95% CI 85.5-109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79-1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45-2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death. CONCLUSION:In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Barra S,Duehmke R,Providência R,Narayanan K,Reitan C,Roubicek T,Polasek R,Chow A,Defaye P,Fauchier L,Piot O,Deharo JC,Sadoul N,Klug D,Garcia R,Dockrill S,Virdee M,Pettit S,Agarwal S,Borgquist R,Marijon E,Boveda

doi

10.1093/eurheartj/ehz238

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

2121-2127

issue

eissn

0195-668X

issn

1522-9645

pii

5482553

journal_volume

pub_type

杂志文章,多中心研究

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Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients.