Author + information
- Aafke Van Der Heijden,
- Ulas Hoke,
- Jan Willem Borleffs,
- Joep Thijssen,
- Johannes van Rees,
- Enno Van Der Velde,
- Martin Schalij and
- Lieselot van Erven
Cardiac resynchronization therapy-defibrillator [CRT-D] implantation reduces the risk of ventricular arrhythmias in patients with left ventricular [LV] reverse remodelling. Some patients show dramatic improvement of LV ejection fraction [LVEF] due to LV reverse remodelling, hereby they outgrow eligibility for ICD. Data on device therapy of these super responders is scarce.
All patients who underwent CRT-D implantation at Leiden University Medical Center are included. Patients are divided in subgroups according reduction in LV end-systolic volume [LVESV], 6 months after implantation. Subgroups are: responders (decreased LVESV 15-30%) and super responders (decreased LVESV >30%), remaining patients were excluded. During follow-up ICD therapy is registered.
During a median follow up of 48±41 months, 522 patients were followed (292 responders, 230 super responders). In 138 (47%) responders and 131 (57%) super responders LVEF was >35% after 6 months. The 5 year cumulative incidence of appropriate therapy is 32% (95% 25-38) in responders and 25% (95% 17-33) in super responders (adjusted P=0.04). The 5 year cumulative incidence of appropriate shock is 18% (95% 13-24) and 11% (95% 6-17) in responders and super responders (adjusted P=0.06).
CRT-D super responders receive significantly less appropriate ICD therapy compared to responders. However, 25% of super responders are treated for a potentially life threatening arrhythmia during follow up.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: Devices II – Improving Outcomes in Patients with Implantable Devices: Tweaking the Well-Functioning Machine
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1190-44
- 2013 American College of Cardiology Foundation