Sérgio Barra1,2,3, Rui Providência4, Kumar Narayanan5,6, Serge Boveda7, Rudolf Duehmke3,8, Rodrigue Garcia9, Francisco Leyva10,11, Véronique Roger12,13, Xavier Jouven6,14,15, Sharad Agarwal3, Wayne C Levy16, Eloi Marijon6,14,15. 1. Cardiology Department, Hospital da Luz Arrabida, Praceta de Henrique Moreira 150, 4400-346 V. N. Gaia, Portugal. 2. Cardiology Department, V. N. Gaia Hospital Center, Rua Conceição Fernandes 4434-502 V. N. Gaia, Portugal. 3. Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Papworth Rd, Cambridge CB2 0AY, UK. 4. Cardiology Department, Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK. 5. Cardiology Department, Medicover Hospitals, Hyderabad, India. 6. Paris Cardiovascular Research Center (Inserm U970), Cardiovascular Epidemiology Unit, 56 Rue Leblanc, 75015 Paris, France. 7. Cardiology Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076 TOULOUSE, 31300 Toulouse, France. 8. Cardiology Department, James Paget University Hospital, Lowestoft Road Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK. 9. Cardiology Department, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France. 10. Aston Medical Research Institute, Aston University Medical School, 295 Aston Express Way, Birmingham B4 7ET, UK. 11. Cardiology Department, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK. 12. Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, 200 1st St SW, Rochester, MN 55905, USA. 13. Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, 200 1st St SW, Rochester, MN 55905, USA. 14. Cardiology Department, European Georges Pompidou Hospital, 20 Rue Leblanc, 75015 Paris, France. 15. Paris Descartes University, 12 Rue de l'École de Médecine, 75006 Paris, France. 16. Division of Cardiology, University of Washington, Seattle, WA, USA.
Abstract
AIMS: While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. METHODS AND RESULTS: Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. CONCLUSION: Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failurepatients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. METHODS AND RESULTS: Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. CONCLUSION:Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Moritz Hadwiger; Nikolaos Dagres; Janina Haug; Michael Wolf; Ursula Marschall; Jan Tijssen; Alexander Katalinic; Fabian Simon Frielitz; Gerhard Hindricks Journal: Eur Heart J Date: 2022-07-14 Impact factor: 35.855