open access

Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-11-26
Get Citation

Predictors for early mortality and arrhythmic events in patients with cardiac resynchronization therapy with defibrillator: A two center cohort study

Simon von Gunten, Dominic A. Theuns, Michael Kühne, Tobias Reichlin, Christian Sticherling, Beat Schaer
DOI: 10.5603/CJ.a2018.0144
·
Pubmed: 30484267
·
Cardiol J 2019;26(6):711-716.

open access

Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-11-26

Abstract

Background: Guidelines of heart failure therapy include cardiac resynchronization as standard of
care in patients with severely depressed left ventricular function and wide QRS complex. It has been
shown that patients benefit regarding mortality and morbidity. However, early mortality precludes longterm
benefits from the device. The aim of the study was to identify predictors for early occurrence of
both death and first-ever implantable cardioverter-defibrillator (ICD) therapy using a large combined
database of patients with cardiac resynchronization therapy with defibrillator (CRT-D).
Methods: From two registries (tertiary care centers) 904 patients were identified, no single patient was
excluded. Early death was defined as death occurring within the 3 years after implantation whereas
early ICD therapy as such occurring within the first year. 33 baseline parameters were compared using
uni- and multivariate analysis with the Cox model and binary logistic regression.
Results: The population was predominantly male (77%), with mean age of 63 ± 11 years and primary
prevention indication in 80%. Mean follow-up was 55 ± 38 months. 256 (28%) patients had
ICD therapies whereof the first-ever event occurred early in 52%. 270 (30%) patients died after 41 ±
± 31 months, mostly from advancing heart failure (41%), 141 (52%) patients of them early. Independent
predictors for early ICD therapy were secondary prevention and renal failure. Independent predictors for
early mortality were a history of percutaneous coronary intervention and of peripheral vascular disease.
Conclusions: Predictors for early mortality after CRT-D implantation were a history of percutaneous
coronary intervention and peripheral vascular disease, present in only a minority of patients, thus limiting
their use in clinical practice.

Abstract

Background: Guidelines of heart failure therapy include cardiac resynchronization as standard of
care in patients with severely depressed left ventricular function and wide QRS complex. It has been
shown that patients benefit regarding mortality and morbidity. However, early mortality precludes longterm
benefits from the device. The aim of the study was to identify predictors for early occurrence of
both death and first-ever implantable cardioverter-defibrillator (ICD) therapy using a large combined
database of patients with cardiac resynchronization therapy with defibrillator (CRT-D).
Methods: From two registries (tertiary care centers) 904 patients were identified, no single patient was
excluded. Early death was defined as death occurring within the 3 years after implantation whereas
early ICD therapy as such occurring within the first year. 33 baseline parameters were compared using
uni- and multivariate analysis with the Cox model and binary logistic regression.
Results: The population was predominantly male (77%), with mean age of 63 ± 11 years and primary
prevention indication in 80%. Mean follow-up was 55 ± 38 months. 256 (28%) patients had
ICD therapies whereof the first-ever event occurred early in 52%. 270 (30%) patients died after 41 ±
± 31 months, mostly from advancing heart failure (41%), 141 (52%) patients of them early. Independent
predictors for early ICD therapy were secondary prevention and renal failure. Independent predictors for
early mortality were a history of percutaneous coronary intervention and of peripheral vascular disease.
Conclusions: Predictors for early mortality after CRT-D implantation were a history of percutaneous
coronary intervention and peripheral vascular disease, present in only a minority of patients, thus limiting
their use in clinical practice.

Get Citation

Keywords

cardiac resynchronization therapy, implantable cardioverter-defibrillator, mortality, predictive model, decision making

About this article
Title

Predictors for early mortality and arrhythmic events in patients with cardiac resynchronization therapy with defibrillator: A two center cohort study

Journal

Cardiology Journal

Issue

Vol 26, No 6 (2019)

Pages

711-716

Published online

2018-11-26

DOI

10.5603/CJ.a2018.0144

Pubmed

30484267

Bibliographic record

Cardiol J 2019;26(6):711-716.

Keywords

cardiac resynchronization therapy
implantable cardioverter-defibrillator
mortality
predictive model
decision making

Authors

Simon von Gunten
Dominic A. Theuns
Michael Kühne
Tobias Reichlin
Christian Sticherling
Beat Schaer

References (13)
  1. Cleland JGF, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352(15): 1539–1549.
  2. Tang ASL, Wells GA, Talajic M, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010; 363(25): 2385–2395.
  3. Daubert JC, Martins R, Leclercq C, et al. Why we have to use cardiac resynchronization therapy-pacemaker more. Card Electrophysiol Clin. 2015; 7(4): 709–720.
  4. Kraaier K, Scholten MF, Tijssen JGP, et al. Early mortality in prophylactic implantable cardioverter-defibrillator recipients: development and validation of a clinical risk score. Europace. 2014; 16(1): 40–46.
  5. Theuns DA, Schaer BA, Soliman OII, et al. The prognosis of implantable defibrillator patients treated with cardiac resynchronization therapy: comorbidity burden as predictor of mortality. Europace. 2011; 13(1): 62–69.
  6. Proclemer A, Muser D, Campana A, et al. Indication to cardioverter-defibrillator therapy and outcome in real world primary prevention. Data from the IRIDE [Italian registry of prophylactic implantation of defibrillators] study. Int J Cardiol. 2013; 168(2): 1416–1421.
  7. Reichlin T, Kühne M, Sticherling C, et al. Characterization and financial impact of implantable cardioverter-defibrillator patients without interventions 5 years after implantation. QJM. 2011; 104(10): 849–857.
  8. Ypenburg C, van Erven L, Bleeker GB, et al. Benefit of combined resynchronization and defibrillator therapy in heart failure patients with and without ventricular arrhythmias. J Am Coll Cardiol. 2006; 48(3): 464–470.
  9. Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991; 10(4): 585–598.
  10. Kramer DB, Friedman PA, Kallinen LM, et al. Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators. Heart Rhythm. 2012; 9(1): 42–46.
  11. Ertel D, Phatak K, Makati K, et al. Predictors of early mortality in patients age 80 and older receiving implantable defibrillators. Pacing Clin Electrophysiol. 2010; 33(8): 981–987.
  12. Husaini M, Biton Y, Stair B, et al. Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients. Cardiol J. 2016; 23(4): 437–445.
  13. Szepietowska B, McNitt S, Polonsky B, et al. Metabolic syndrome is associated with different clinical outcome after cardiac resynchronization therapy in patients with ischemic and non-ischemic cardiomyopathy. Cardiol J. 2016; 23(3): 344–351.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl