RT Journal Article
SR Electronic
T1 Device complications with addition of defibrillation to cardiac resynchronisation therapy for primary prevention
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1529
OP 1535
DO 10.1136/heartjnl-2017-312546
VO 104
IS 18
A1 Sérgio Barra
A1 Rui Providência
A1 Serge Boveda
A1 Rudolf Duehmke
A1 Kumar Narayanan
A1 Anthony W Chow
A1 Olivier Piot
A1 Didier Klug
A1 Pascal Defaye
A1 Daniel Gras
A1 Jean-Claude Deharo
A1 Paul Milliez
A1 Antoine Da Costa
A1 Pierre Mondoly
A1 Jorge Gonzalez-Panizo
A1 Christophe Leclercq
A1 Patrick Heck
A1 Munmohan Virdee
A1 Nicolas Sadoul
A1 Jean-Yves Le Heuzey
A1 Eloi Marijon
YR 2018
UL http://heart.bmj.com/content/104/18/1529.abstract
AB Objective In patients indicated for cardiac resynchronisation therapy (CRT), the choice between a CRT-pacemaker (CRT-P) versus defibrillator (CRT-D) remains controversial and indications in this setting have not been well delineated. Apart from inappropriate therapies, which are inherent to the presence of a defibrillator, whether adding defibrillator to CRT in the primary prevention setting impacts risk of other acute and late device-related complications has not been well studied and may bear relevance for device selection.Methods Observational multicentre European cohort study of 3008 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias, undergoing CRT implantation with (CRT-D, n=1785) or without (CRT-P, n=1223) defibrillator. Using propensity score and competing risk analyses, we assessed the risk of significant device-related complications requiring surgical reintervention. Inappropriate shocks were not considered except those due to lead malfunction requiring lead revision.Results Acute complications occurred in 148 patients (4.9%), without significant difference between groups, even after considering potential confounders (OR=1.20, 95% CI 0.72 to 2.00, p=0.47). During a mean follow-up of 41.4±29 months, late complications occurred in 475 patients, giving an annual incidence rate of 26 (95% CI 9 to 43) and 15 (95% CI 6 to 24) per 1000 patient-years in CRT-D and CRT-P patients, respectively. CRT-D was independently associated with increased occurrence of late complications (HR=1.68, 95% CI 1.27 to 2.23, p=0.001). In particular, when compared with CRT-P, CRT-D was associated with an increased risk of device-related infection (HR 2.10, 95% CI 1.18 to 3.45, p=0.004). Acute complications did not predict overall late complications, but predicted device-related infection (HR 2.85, 95% CI 1.71 to 4.56, p<0.001).Conclusions Compared with CRT-P, CRT-D is associated with a similar risk of periprocedural complications but increased risk of long-term complications, mainly infection. This needs to be considered in the decision of implanting CRT with or without a defibrillator.