Sérgio Barra1,2,3, Rudolf Duehmke4, Rui Providência5, Kumar Narayanan6,7, Christian Reitan8, Tomas Roubicek9, Rostislav Polasek9, Antony Chow5, Pascal Defaye10, Laurent Fauchier11,12, Olivier Piot13, Jean-Claude Deharo14, Nicolas Sadoul15, Didier Klug16, Rodrigue Garcia17, Seth Dockrill3, Munmohan Virdee3, Stephen Pettit3, Sharad Agarwal3, Rasmus Borgquist8, Eloi Marijon7,18,19, Serge Boveda20. 1. Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal. 2. Cardiology Department, V. N. Gaia Hospital Center, V. N. Gaia, Portugal. 3. Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK. 4. Cardiology Department, West Suffolk Hospital, West Suffolk, UK. 5. Cardiology Department, Barts Heart Centre, Barts Health NHS Trust, London, UK. 6. Cardiology Department, MaxCure Hospitals, Hyderabad, India. 7. Paris Cardiovascular Research Center (Inserm U970), Cardiovascular Epidemiology Unit, Paris, France. 8. Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Lund, Sweden. 9. Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic. 10. Arrhythmia Department, University Hospital, Grenoble, France. 11. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France. 12. Faculté de Médecine, Université François Rabelais, Tours, France. 13. Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France. 14. Cardiology Division, Hôpital La Timone, Marseille, France. 15. Cardiology Division, Nancy University Hospital, Nancy, France. 16. Cardiology Division, Lille University Hospital and University of Lille, Lille, France. 17. Cardiology Division, Poitiers University Hospital, Poitiers, France. 18. Cardiology Department, European Georges Pompidou Hospital, Paris, France. 19. Paris Descartes University, Paris, France. 20. Cardiology Department, Clinique Pasteur, Toulouse, France.
Abstract
AIMS: The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D). METHODS AND RESULTS: A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10-42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3-45.5] and 97.2 (95% CI 85.5-109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79-1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45-2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death. CONCLUSION: In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D). METHODS AND RESULTS: A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10-42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3-45.5] and 97.2 (95% CI 85.5-109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79-1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45-2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death. CONCLUSION: In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator. Published on behalf of the European Society of Cardiology. All rights reserved.
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