Increased mortality and ICD therapies in ischemic versus non-ischemic dilated cardiomyopathy patients with cardiac resynchronization having survived until first device replacement

Abstract

Introduction Cardiac resynchronization therapy combined with an implantable cardioverter defibrillator (CRT-D) is widely applied in heart failure patients. Sufficient data on arrhythmia and defibrillator therapies during long-term follow-up of more than 4 years are lacking and data on mortality are conflicting. We aimed to characterize the occurrence of ventricular arrhythmia, respective defibrillator therapies and mortality for several years following CRT-D implantation or upgrade. Material and methods Eighty-eight patients with ischemic (ICM) or non-ischemic dilated cardiomyopathy (DCM) and at least one CRT-D replacement were included in this study and analyzed for incidence of non-sustained ventricular tachycardia (NSVT), defibrillator shocks, anti-tachycardia pacing (ATP) and mortality. Results ICM was the underlying disease in 59%, DCM in 41% of patients. During a mean follow-up of 76.4 ±24.8 months the incidence of appropriate defibrillator therapies (shock or ATP) was 46.6% and was elevated in ICM compared to DCM patients (57.7% vs. 30.6%, respectively; p = 0.017). Kaplan-Meier analysis revealed significantly higher ICD therapy-free survival rates in DCM patients ( p = 0.031). Left ventricular ejection fraction, NSVT per year and ICM (vs. DCM) were independent predictors of device intervention. The ICM patients showed increased mortality compared to DCM patients, with cumulative all-cause mortality at 9 years of follow-up of 45.4% and 10.6%, respectively. Chronic renal failure, peripheral artery disease and chronic obstructive pulmonary disease were independent predictors of mortality. Conclusions The clinical course of patients with ICM and DCM treated with CRT-D differs significantly during long-term follow-up, with increased mortality and incidence of ICD therapies in ICM patients.

Diagnosis of Atrial Fibrillation in Heart Failure Patients With Implantable Cardioverter Defibrillator or Cardiac Resynchronisation Therapy.

“…Risk of death in the observed group was statistically significantly higher in patients with chronic kidney disease, which was also confirmed in other studies in patients with ischemic and non-ischemic cardiomyopathy and implanted CRT-D [ 21 ].…”

Prognostic value of lung ultrasonography and bioimpedance spectroscopy in patients with heart failure and reduced ejection fraction

“…Similar findings were also observed in European populations [2,3]. Despite important advances in diagnosis and management over the past two decades [4], chronic HF patients still have a poor prognosis [1,[5][6][7][8] with a mortality around 50% at five years [9].…”

Ischemic Cardiomyopathy versus Non-Ischemic Dilated Cardiomyopathy in Patients with Reduced Ejection Fraction— Clinical Characteristics and Prognosis Depending on Heart Failure Etiology (Data from European Society of Cardiology Heart Failure Registries)

“…Nevertheless, on average, patients with ICM are at a greater risk of SCD than patients with NIDCM [ 1 , 28 ]. Therefore, although the relative benefits are similar, the absolute benefit is greater in patients with ICM [ 1 , 11 ].…”

“…Previous studies have reported conflicting results in terms of mortality risk in patients with ICM and NIDCM [ 6 , 7 , 8 , 9 , 10 ]. Patients with ICM are at a greater risk of sudden cardiac death (SCD) than patients with NIDCM; thus, the benefits resulting from implantable cardioverter defibrillators (ICDs) are greater in the first group [ 1 , 11 ]. What is more, a recently published nationwide study has shown one-year mortality to be significantly higher in ICM than in NIDCM patients after ICD implantation for primary prevention of SCD [ 12 ].…”