Survival and Heart Failure Hospitalization in Patients With Cardiac Resynchronization Therapy With or Without a Defibrillator for Primary Prevention in Japan　― Analysis of the Japan Cardiac Device Treatment Registry Database

• Published in: Circulation Journal Vol. 81; no. 12; pp. 1798 - 1806
• Main Authors: Yokoshiki, Hisashi, Shimizu, Akihiko, Mitsuhashi, Takeshi, Furushima, Hiroshi, Sekiguchi, Yukio, Manaka, Tetsuyuki, Nishii, Nobuhiro, Ueyama, Takeshi, Morita, Norishige, Okamura, Hideo, Nitta, Takashi, Hirao, Kenzo, Okumura, Ken, for the Members of the Implantable Cardioverter-Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.11.2017
• Subjects: Cardiac resynchronization therapy (CRT); CRT defibrillator (CRT-D); CRT pacemaker (CRT-P); Primary prevention; CRT defibrillator (CRT-D); CRT pacemaker (CRT-P); Primary prevention; Cardiac resynchronization therapy (CRT)
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-0234

Background:Randomized control trials comparing the effectiveness of cardiac resynchronization therapy devices, with (CRT-D) or without (CRT-P) a defibrillator, are scarce in heart failure patients with no prior sustained ventricular tachyarrhythmias.Methods and Results:The Japan Cardiac Device Treatment Registry (JCDTR) has data for 2714 CRT-D and 555 CRT-P recipients for primary prevention with an implantation date between January 2011 and August 2015. Of these patients, follow-up data were available for 717. Over the mean follow-up period of 21 months, Kaplan-Meier curves of survival free of combined events for all-cause death or heart failure hospitalization (whichever came first) diverged between the CRT-D (n=620) and CRT-P (n=97) groups with a rate of 22% vs. 42%, respectively, at 24 months (P=0.0011). However, this apparent benefit of CRT-D over CRT-P was no longer significant after adjustment for covariates. With regard to mortality, including heart failure death or sudden cardiac death, there was no significant difference between the 2 groups.Conclusions:In patients without sustained ventricular tachyarrhythmias enrolled in the JCDTR, there was no significant difference in mortality between the CRT-D and CRT-P groups, despite a lower trend in CRT-D recipients. This study was limited by large clinical and demographic differences between the 2 groups.