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Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo-Tcheugui JB, Martin DT, Joseph J, Singh JP. Ongoing Risk of Ventricular Arrhythmias and All-Cause Mortality at Implantable Cardioverter Defibrillator Generator Change: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2021; 14:e009139. [PMID: 33554611 DOI: 10.1161/circep.120.009139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Matthew F Yuyun
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Sebhat A Erqou
- Brown University (S.A.E.), RI.,Providence VA Medical Center (S.A.E.), RI
| | - Adelqui O Peralta
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Peter S Hoffmeister
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York (H.Y.)
| | | | - David T Martin
- Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Brigham and Women's Hospital (D.T.M., J.J.), Boston
| | - Jacob Joseph
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Brigham and Women's Hospital (D.T.M., J.J.), Boston
| | - Jagmeet P Singh
- Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Massachusetts General Hospital (J.P.S.), Boston
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Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo Tcheugui JB, Martin DT, Joseph J, Singh JP. Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis. Europace 2021; 23:1262-1274. [PMID: 33496319 DOI: 10.1093/europace/euaa414] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. METHODS AND RESULTS We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001). CONCLUSIONS Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.
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Affiliation(s)
- Matthew F Yuyun
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Sebhat A Erqou
- Department of Medicine, Brown University, Providence, RI, USA.,Division of Cardiology, Providence VA Medical Center, Providence, RI, USA
| | - Adelqui O Peralta
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Peter S Hoffmeister
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | | | - David T Martin
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob Joseph
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
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