Effect of cardiac resynchronization therapy with implantable cardioverter defibrillator versus cardiac resynchronization therapy with pacemaker on mortality in heart failure patients: results of a high-volume, single-centre experience

Valentina Kutyifa, Laszlo Geller, Peter Bogyi, Endre Zima, Mehmet K Aktas, Emin Evren Ozcan, David Becker, Vivien Klaudia Nagy, Annamaria Kosztin, Szabolcs Szilagyi, Bela Merkely, Valentina Kutyifa, Laszlo Geller, Peter Bogyi, Endre Zima, Mehmet K Aktas, Emin Evren Ozcan, David Becker, Vivien Klaudia Nagy, Annamaria Kosztin, Szabolcs Szilagyi, Bela Merkely

Abstract

Aims: There are limited and contradictory data on the effects of CRT with implantable cardioverter defibrillator (CRT-D) on mortality as compared with CRT with pacemaker (CRT-P).

Methods and results: We evaluated the long-term outcome of patients implanted with a CRT-D or CRT-P device in our high-volume single-centre experience. Data on all-cause mortality were derived from clinic visits and the Hungarian National Healthcare Fund Death Registry. Kaplan-Meier survival analyses and multivariate Cox regression models were used to evaluate all-cause mortality in patients with CRT-D vs. CRT-P, stratified by the aetiology of cardiomyopathy. From 2000 to 2011, 1122 CRT devices, 693 CRT-P (LVEF 28.2 ± 7.4%) and 429 CRT-D (LVEF 27.6 ± 6.4%), were implanted at our centre. During the median follow-up of 28 months, 379 patients died from any cause, 250 patients (36%) with an implanted CRT-P and 129 patients (30%) with an implanted CRT-D. There was no evidence of mortality benefit in patients implanted with a CRT-D compared with a CRT-P in the total cohort [hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.73-1.32, P = 0.884]. In patients with ischaemic cardiomyopathy, CRT-D treatment was associated with a significant 30% risk reduction in all-cause mortality compared with an implanted CRT-P (HR 0.70, 95% CI 0.51-0.97, P = 0.03). In non-ischaemic patients, there was no mortality benefit of CRT-D over CRT-P (HR 0.98, 95% CI 0.73-1.32, P = 0.894, interaction P-value = 0.15).

Conclusions: In heart failure patients with ischaemic cardiomyopathy, CRT-D was associated with a mortality benefit compared with CRT-P, but no benefit of CRT-D over CRT-P in mortality was observed in non-ischaemic cardiomyopathy.

Keywords: Cardiac resynchronization therapy; Heart failure; Implantable cardioverter defibrillator; Mortality.

© 2014 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1
Figure 1
Echocardiographic response to cardiac resynchronization therapy with implantable cardioverter defibrillator (CRT-D) vs. cardiac resynchronization therapy with pacemaker (CRT-P), stratified by ischaemic aetiology.
Figure 2
Figure 2
Cumulative probability of all-cause mortality (A) in ischaemic vs. non-ischaemic cardiomyopathy patients and (B) in patients with cardiac resynchronization therapy with implantable cardioverter defibrillator (CRT-D) vs. cardiac resynchronization therapy with pacemaker CRT-P).
Figure 3
Figure 3
Cumulative probability of all-cause mortality in patients with cardiac resynchronization therapy with implantable cardioverter defibrillator (CRT-D) vs. cardiac resynchronization therapy with pacemaker (CRT-P) (A) in ischaemic cardiomyopathy and (B) in non-ischaemic cardiomyopathy patients.

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