Benefit of combined resynchronization and defibrillator therapy in heart failure patients with and without ventricular arrhythmias.

Abstract:

OBJECTIVES:We attempted to assess the efficacy of combined cardiac resynchronization therapy-implantable cardioverter-defibrillator (CRT-ICD) in heart failure patients with and without ventricular arrhythmias. BACKGROUND:Because CRT and ICDs both lower all-cause mortality in patients with advanced heart failure, combination of both therapies in a single device is challenging. METHODS:A total of 191 consecutive patients with advanced heart failure, left ventricular ejection fraction <35%, and a QRS duration >120 ms received CRT-ICD. Seventy-one patients had a history of ventricular arrhythmias (secondary prevention); 120 patients did not have prior ventricular arrhythmias (primary prevention). During follow-up, ICD therapy rate, clinical improvement after 6 months, and mortality rate were evaluated. RESULTS:During follow-up (18 +/- 4 months), primary prevention patients experienced less appropriate ICD therapies than secondary prevention patients (21% vs. 35%, p < 0.05). Multivariate analysis revealed, however, no predictors of ICD therapy. Furthermore, a similar, significant, improvement in clinical parameters was observed at 6 months in both groups. Also, the mortality rate in the primary prevention group was lower than in the secondary prevention group (3% vs. 18%, p < 0.05). CONCLUSIONS:As 21% of the primary prevention patients and 35% of the secondary prevention patients experienced appropriate ICD therapy within 2 years after implant, and no predictors of ICD therapy could be identified, implantation of a CRT-ICD device should be considered in all patients eligible for CRT.

journal_name

J Am Coll Cardiol

authors

Ypenburg C,van Erven L,Bleeker GB,Bax JJ,Bootsma M,Wijffels MC,van der Wall EE,Schalij MJ

doi

10.1016/j.jacc.2006.04.072

subject

Has Abstract

pub_date

2006-08-01 00:00:00

pages

464-70

issue

3

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(06)01248-4

journal_volume

48

pub_type

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