Outcomes of Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic
Francisco Leyva1, Abbasin Zegard2, Edmund Acquaye3
1Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom. Electronic address: http://www.doctorleyva.com.
Journal of the American College of Cardiology
|September 2, 2017
Summary
Cardiac resynchronization therapy with defibrillation (CRT-D) is superior to pacing (CRT-P) for nonischemic cardiomyopathy patients with left ventricular midwall fibrosis. For patients without fibrosis, CRT-P and CRT-D showed similar outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Cardiac Imaging
Background:
- Cardiac resynchronization therapy (CRT) benefits in nonischemic cardiomyopathy (NICM) are debated.
- Left ventricular myocardial scar is linked to poor clinical outcomes in NICM patients.
Purpose of the Study:
- To compare CRT-D versus CRT-P efficacy in NICM patients.
- To assess the impact of left ventricular midwall fibrosis (MWF) on CRT outcomes.
- To determine if CRT-D is superior to CRT-P in NICM patients with or without MWF.
Main Methods:
- Cardiac magnetic resonance (CMR) identified MWF in NICM patients.
- Patients were stratified into MWF-positive (n=68) and MWF-negative (n=184) groups.
- Clinical events were tracked post-CRT device implantation.
Main Results:
- MWF independently predicted mortality and adverse cardiac events in the total cohort.
- CRT-D demonstrated superior outcomes compared to CRT-P in MWF-positive patients.
- No significant difference in outcomes between CRT-D and CRT-P was observed in MWF-negative patients.
Conclusions:
- CRT-D offers superior clinical benefits over CRT-P in NICM patients with left ventricular midwall fibrosis.
- Device selection for NICM patients should consider the presence or absence of MWF.
- Findings guide personalized CRT device therapy decisions.
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