Super-response to cardiac resynchronization therapy reduces appropriate implantable cardioverter defibrillator therapy

Ammar M. Killu, Anna Mazo, Avishay Grupper, Malini Madhavan, Tracy Webster, Kelly L. Brooke, David O. Hodge, Samuel J Asirvatham, Paul Andrew Friedman, Michael Glikson, Yong-Mei Cha

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Aims: To determine the frequency of implantable cardioverter defibrillator (ICD) therapy following cardiac resynchronization therapy (CRT-D) implantation in super and non-super responders and whether greater improvement in left ventricular (LV) function after CRT is associated with a reduced burden in ICD therapy. Methods and results: This is a two-centre, retrospective study between January 2002 and September 2011. Patients were classified as nonsuper responders and super-responders based on the post-CRT ejection fraction (EF) of < 50% and ≥50%, respectively. Of 629 recipients of CRT-D, 37 (5.9%) were super-responders. Implantable cardioverter defibrillator follow-up was available for a mean duration of 6.2 ± 2.7 years. The 5-year rate of antitachycardia pacing (ATP) in super-responders was significantly lower than in non-super responders (2.7% vs. 22.1%, P = 0.004). Super-responders also had a lower 5-year rate of appropriate ICD shock compared with non-super responders (2.7% vs. 14.3%, P = 0.03). On multivariable analysis, factors associated with appropriate ICD therapy (ICD shock/ATP) include male gender (hazard ratio, HR 1.97, 95% confidence interval, 95% CI 1.15-3.35), secondary prevention indication (HR 2.09, 95% CI 1.13-3.85), increased baseline LV end-systolic diameter (HR 1.03 per mm, 95% CI 1.01-1.06) and higher baseline EF (HR 1.03 per %, 95% CI 1.00-1.06) while super-responder status was highly protective (HR 0.13, 95% CI 0.02-0.91). Conclusion: Recipients of CRT-D that normalize their EF have very low rates of ventricular arrhythmias requiring appropriate ICD therapy compared with those that do not.

Original languageEnglish (US)
Pages (from-to)1303-1311
Number of pages9
JournalEuropace
Volume20
Issue number8
DOIs
StatePublished - Jan 1 2018

Fingerprint

Cardiac Resynchronization Therapy
Implantable Defibrillators
Therapeutics
Shock
Secondary Prevention
Left Ventricular Function
Cardiac Arrhythmias
Retrospective Studies
Confidence Intervals

Keywords

  • Cardiac resynchronization
  • Cardiac resynchronization therapy
  • Defibrillator
  • Heart failure
  • Implantable cardioverterdefibrillator
  • Mortality
  • Response
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Super-response to cardiac resynchronization therapy reduces appropriate implantable cardioverter defibrillator therapy. / Killu, Ammar M.; Mazo, Anna; Grupper, Avishay; Madhavan, Malini; Webster, Tracy; Brooke, Kelly L.; Hodge, David O.; Asirvatham, Samuel J; Friedman, Paul Andrew; Glikson, Michael; Cha, Yong-Mei.

In: Europace, Vol. 20, No. 8, 01.01.2018, p. 1303-1311.

Research output: Contribution to journalArticle

Killu, Ammar M. ; Mazo, Anna ; Grupper, Avishay ; Madhavan, Malini ; Webster, Tracy ; Brooke, Kelly L. ; Hodge, David O. ; Asirvatham, Samuel J ; Friedman, Paul Andrew ; Glikson, Michael ; Cha, Yong-Mei. / Super-response to cardiac resynchronization therapy reduces appropriate implantable cardioverter defibrillator therapy. In: Europace. 2018 ; Vol. 20, No. 8. pp. 1303-1311.
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T1 - Super-response to cardiac resynchronization therapy reduces appropriate implantable cardioverter defibrillator therapy

AU - Killu, Ammar M.

AU - Mazo, Anna

AU - Grupper, Avishay

AU - Madhavan, Malini

AU - Webster, Tracy

AU - Brooke, Kelly L.

AU - Hodge, David O.

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

AU - Glikson, Michael

AU - Cha, Yong-Mei

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N2 - Aims: To determine the frequency of implantable cardioverter defibrillator (ICD) therapy following cardiac resynchronization therapy (CRT-D) implantation in super and non-super responders and whether greater improvement in left ventricular (LV) function after CRT is associated with a reduced burden in ICD therapy. Methods and results: This is a two-centre, retrospective study between January 2002 and September 2011. Patients were classified as nonsuper responders and super-responders based on the post-CRT ejection fraction (EF) of < 50% and ≥50%, respectively. Of 629 recipients of CRT-D, 37 (5.9%) were super-responders. Implantable cardioverter defibrillator follow-up was available for a mean duration of 6.2 ± 2.7 years. The 5-year rate of antitachycardia pacing (ATP) in super-responders was significantly lower than in non-super responders (2.7% vs. 22.1%, P = 0.004). Super-responders also had a lower 5-year rate of appropriate ICD shock compared with non-super responders (2.7% vs. 14.3%, P = 0.03). On multivariable analysis, factors associated with appropriate ICD therapy (ICD shock/ATP) include male gender (hazard ratio, HR 1.97, 95% confidence interval, 95% CI 1.15-3.35), secondary prevention indication (HR 2.09, 95% CI 1.13-3.85), increased baseline LV end-systolic diameter (HR 1.03 per mm, 95% CI 1.01-1.06) and higher baseline EF (HR 1.03 per %, 95% CI 1.00-1.06) while super-responder status was highly protective (HR 0.13, 95% CI 0.02-0.91). Conclusion: Recipients of CRT-D that normalize their EF have very low rates of ventricular arrhythmias requiring appropriate ICD therapy compared with those that do not.

AB - Aims: To determine the frequency of implantable cardioverter defibrillator (ICD) therapy following cardiac resynchronization therapy (CRT-D) implantation in super and non-super responders and whether greater improvement in left ventricular (LV) function after CRT is associated with a reduced burden in ICD therapy. Methods and results: This is a two-centre, retrospective study between January 2002 and September 2011. Patients were classified as nonsuper responders and super-responders based on the post-CRT ejection fraction (EF) of < 50% and ≥50%, respectively. Of 629 recipients of CRT-D, 37 (5.9%) were super-responders. Implantable cardioverter defibrillator follow-up was available for a mean duration of 6.2 ± 2.7 years. The 5-year rate of antitachycardia pacing (ATP) in super-responders was significantly lower than in non-super responders (2.7% vs. 22.1%, P = 0.004). Super-responders also had a lower 5-year rate of appropriate ICD shock compared with non-super responders (2.7% vs. 14.3%, P = 0.03). On multivariable analysis, factors associated with appropriate ICD therapy (ICD shock/ATP) include male gender (hazard ratio, HR 1.97, 95% confidence interval, 95% CI 1.15-3.35), secondary prevention indication (HR 2.09, 95% CI 1.13-3.85), increased baseline LV end-systolic diameter (HR 1.03 per mm, 95% CI 1.01-1.06) and higher baseline EF (HR 1.03 per %, 95% CI 1.00-1.06) while super-responder status was highly protective (HR 0.13, 95% CI 0.02-0.91). Conclusion: Recipients of CRT-D that normalize their EF have very low rates of ventricular arrhythmias requiring appropriate ICD therapy compared with those that do not.

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KW - Cardiac resynchronization therapy

KW - Defibrillator

KW - Heart failure

KW - Implantable cardioverterdefibrillator

KW - Mortality

KW - Response

KW - Treatment

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