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 A. Friedman, Michael Glikson, Yong Mei Cha

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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