Hisashi Yokoshiki1, Akihiko Shimizu2, Takeshi Mitsuhashi3, Hiroshi Furushima4, Yukio Sekiguchi5, Tetsuyuki Manaka6, Nobuhiro Nishii7, Takeshi Ueyama8, Norishige Morita9, Hideo Okamura10, Takashi Nitta11, Kenzo Hirao12, Ken Okumura13. 1. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine. 2. Faculty of Health Sciences, Yamaguchi Graduate School of Medicine. 3. Cardiovascular Medicine, Jichi Medical University Saitama Medical Center. 4. Furushima Clinic. 5. Cardiovascular Division, Faculty of Medicine, University of Tsukuba. 6. Asakusa Heart Clinic. 7. Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences. 8. Division of Cardiology, Department of Medicine and Clinical Sciences, Yamaguchi Graduate School of Medicine. 9. Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital. 10. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center. 11. Department of Cardiovascular Surgery, Nippon Medical School. 12. Heart Rhythm Center, Tokyo Medical and Dental University. 13. Cardiovascular Center, Saiseikai Kumamoto Hospital.
Abstract
BACKGROUND: Randomized control trials comparing the effectiveness of cardiac resynchronization therapy devices, with (CRT-D) or without (CRT-P) a defibrillator, are scarce in heart failure patients with no prior sustained ventricular tachyarrhythmias.Methods and Results: The Japan Cardiac Device Treatment Registry (JCDTR) has data for 2714 CRT-D and 555 CRT-P recipients for primary prevention with an implantation date between January 2011 and August 2015. Of these patients, follow-up data were available for 717. Over the mean follow-up period of 21 months, Kaplan-Meier curves of survival free of combined events for all-cause death or heart failure hospitalization (whichever came first) diverged between the CRT-D (n=620) and CRT-P (n=97) groups with a rate of 22% vs. 42%, respectively, at 24 months (P=0.0011). However, this apparent benefit of CRT-D over CRT-P was no longer significant after adjustment for covariates. With regard to mortality, including heart failure death or sudden cardiac death, there was no significant difference between the 2 groups. CONCLUSIONS: In patients without sustained ventricular tachyarrhythmias enrolled in the JCDTR, there was no significant difference in mortality between the CRT-D and CRT-P groups, despite a lower trend in CRT-D recipients. This study was limited by large clinical and demographic differences between the 2 groups.
BACKGROUND: Randomized control trials comparing the effectiveness of cardiac resynchronization therapy devices, with (CRT-D) or without (CRT-P) a defibrillator, are scarce in heart failurepatients with no prior sustained ventricular tachyarrhythmias.Methods and Results: The Japan Cardiac Device Treatment Registry (JCDTR) has data for 2714 CRT-D and 555 CRT-P recipients for primary prevention with an implantation date between January 2011 and August 2015. Of these patients, follow-up data were available for 717. Over the mean follow-up period of 21 months, Kaplan-Meier curves of survival free of combined events for all-cause death or heart failure hospitalization (whichever came first) diverged between the CRT-D (n=620) and CRT-P (n=97) groups with a rate of 22% vs. 42%, respectively, at 24 months (P=0.0011). However, this apparent benefit of CRT-D over CRT-P was no longer significant after adjustment for covariates. With regard to mortality, including heart failure death or sudden cardiac death, there was no significant difference between the 2 groups. CONCLUSIONS: In patients without sustained ventricular tachyarrhythmias enrolled in the JCDTR, there was no significant difference in mortality between the CRT-D and CRT-P groups, despite a lower trend in CRT-D recipients. This study was limited by large clinical and demographic differences between the 2 groups.
Authors: Samaneh Salimian; Marc W Deyell; Jason G Andrade; Santabhanu Chakrabarti; Matthew T Bennett; Andrew D Krahn; Nathaniel M Hawkins Journal: Heart Rhythm O2 Date: 2021-12-17