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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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The benefits of defibrillator in heart failure patients with cardiac resynchronization therapy: A meta-analysis

Yu-Xiang Long1, Yue Hu1, Di-Yu Cui1

  • 1Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Pacing and Clinical Electrophysiology : PACE
|December 29, 2020
PubMed

Insights

Adding an implantable cardioverter-defibrillator (ICD) to cardiac resynchronization therapy (CRT) significantly reduces all-cause mortality in most patients. However, this survival benefit was not observed in elderly patients or those with nonischemic cardiomyopathy.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • Current guidelines lack recommendations for additional implantable cardioverter-defibrillators (ICDs) in cardiac resynchronization therapy (CRT) patients.
  • The use of ICDs with CRT remains controversial due to limited randomized controlled trial evidence.

Purpose of the Study:

  • To systematically evaluate the impact of adding an implantable cardioverter-defibrillator (ICD) to cardiac resynchronization therapy (CRT) on all-cause mortality.
  • To compare outcomes between cardiac resynchronization therapy with a defibrillator (CRT-D) and cardiac resynchronization therapy with a pacemaker (CRT-P).

Main Methods:

  • A systematic literature search was conducted across PubMed, Embase, and Cochrane CENTRAL up to May 2020.
  • Meta-analysis of 21 studies involving 69,919 patients was performed using a random-effect model.
  • Adjusted hazard ratios (aHR) for all-cause mortality were pooled and analyzed, including subgroup analyses.

Main Results:

  • Cardiac resynchronization therapy with a defibrillator (CRT-D) significantly reduced all-cause mortality compared to cardiac resynchronization therapy with a pacemaker (CRT-P) (aHR: 0.80).
  • A significant mortality benefit was observed in patients with ischemic cardiomyopathy (aHR: 0.74) and for primary prevention (aHR: 0.87).
  • No significant difference in mortality was found for patients with nonischemic cardiomyopathy (aHR: 0.91) or those aged 75 years or older (aHR: 0.96).

Conclusions:

  • Additional implantable cardioverter-defibrillator (ICD) therapy is associated with reduced all-cause mortality in patients receiving cardiac resynchronization therapy (CRT).
  • The survival benefit of adding an ICD to CRT may not extend to elderly patients (≥75 years) or those with nonischemic cardiomyopathy.
  • Further research may be needed to refine indications for ICD implantation in specific patient subgroups undergoing CRT.
Abstract

Keywords:
all-cause mortalitycardiac resynchronization therapydefibrillatorheart failuremeta-analysis

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