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

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

Simon von Gunten1, Dominic A. Theuns2, Michael Kühne1, Tobias Reichlin1, Christian Sticherling1, Beat Schaer1
Pubmed: 30484267
Cardiol J 2019;26(6):711-716.

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.

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