Optimizing Patient Selection for Cardiac Resynchronization Therapy With or Without Defibrillator in a Multicenter...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• The MADIT-ICD benefit score (MBS) is established for implantable cardioverter defibrillator (ICD) selection.
• Optimal patient selection for cardiac resynchronization therapy (CRT) remains an area of investigation.
• The applicability of the MBS in Japanese CRT patient populations requires evaluation.

Purpose of the Study:

• To assess the utility of the MADIT-ICD benefit score (MBS) in identifying suitable candidates for cardiac resynchronization therapy with a defibrillator (CRT-D) in a Japanese population.
• To evaluate the MBS's ability to predict ventricular tachycardia/fibrillation (VT/VF) and non-arrhythmic mortality (AM) in CRT patients.

Main Methods:

• A multicenter study involving 400 primary prevention CRT patients in Japan.
• Patients were stratified into lowest, intermediate, and highest benefit groups based on the MBS.
• Cumulative incidence of VT/VF and AM was assessed over a median follow-up of 34 months.
• Multivariate analyses were performed to identify predictors of VT/VF and AM.

Main Results:

• The MBS demonstrated significant associations with both VT/VF events and non-arrhythmic mortality.
• VT/VF occurred significantly more often in intermediate and highest benefit groups compared to the lowest.
• Non-arrhythmic death was also significantly higher in the intermediate and lowest benefit groups.
• Predictors for VT/VF included VT/VF score ≥7 and presence of left bundle branch block.
• Predictors for non-arrhythmic death included Non-AM score ≥3, systolic blood pressure <100 mmHg, and eGFR <30 mL/min/1.73 m².

Conclusions:

• The MADIT-ICD benefit score is a valuable tool for selecting appropriate candidates for CRT-D in Japanese patients.
• The MBS aids in stratifying risk for both life-threatening arrhythmias and non-arrhythmic mortality.