Heart Failure -> Heart Failure Management: -> Clinical Trials D-PO05 - Poster Session V (ID 39) Poster

D-PO05-119 - Predictor Of Appropriate Implantable Cardioverter Defibrillator Therapy And Prior Death In Patients With Crt (ID 612)


Background: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure patients with wide QRS duration. However, decision-making regarding selection of CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) is an ongoing debate. Although CRT-D has the benefit to save patients with lethal ventricular arrhythmia, CRT-D has several disadvantages compared to a CRT-P, such as risk of inappropriate shocks, more lead-related complications, impaired battery longevity, and higher costs. The patients who died without appropriate ICD therapy (prior death) may be suitable for CRT-P.
Objective: The purpose of this study was to examine the predictor of appropriate ICD therapy including sustained ventricular arrhythmia and prior death in patients with CRT.
Methods: From 2010 to 2019, we retrospectively collected clinical data in patients with CRT in our institute.
Results: Totally 149 patients were included. 143patients were implanted CRT-D and 6patients were implanted CRT-P. 36patients were implanted CRT for secondary prevention (SP), 107patients were implanted CRT for primary prevention (PP). During median follow up periods of 33 months, appropriate ICD therapy was occurred in 14 (38.9%) SP patients and in 41 (38.3%) PP patients. Sustained ventricular arrhythmia required emergent therapy was not recognized in patients with CRT-P. 18 of 31patients died without appropriate ICD therapy (prior death). The Kaplan-Meier curve indicated that there was no significant difference in cumulative appropriate ICD therapy events rate at 12 months between SP and PP (29% vs, 26%, p =0.76). In PP patients, on univariate Cox regression analysis, history of ventricular tachycardia, atrial fibrillation, ischemic heart disease, sex, age, upgrade from pacemaker of ICD, administration of amiodarone, responder were not predictors of appropriate ICD therapy. Also, there was no predictor of prior death.
Conclusion: The CRT patients for PP had same risk of appropriate ICD therapy compared with those for SP. Considering high rate of appropriate ICD therapy and no predictor for future ventricular arrhythmia or prior death, CRT-D may be suitable for almost patients with CRT.