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CRT with defibrillation trumps pacing in NICM patients with +MWF

07 Sep 2017
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Cardiac resynchronization therapy with defibrillation (CRT-D) is superior to CRT(-P) with pacing in nonischaemic cardiomyopathy (NICM) patients with left ventricular midwall fibrosis (+MWF) but not in those without (-MWF), according to a recent study.

Researchers calculated clinical events in patients with NICM who were +MWF (n=68) or ‒MWF (n=184) and who underwent cardiac magnetic resonance prior to CRT device implantation to determine whether CRT-D was better than CRT-P.

Among the included patients, +MWF appeared to independently predict total mortality (adjusted hazard ratio [aHR], 2.31; 95 percent CI, 1.45 to 3.68), total mortality or heart failure hospitalization (aHR, 2.02; 1.32 to 3.09), total mortality or hospitalization for major adverse cardiac events (aHR, 2.02; 1.32 to 3.07), death from pump failure (aHR, 1.95; 1.11 to 3.41), and sudden cardiac death (aHR, 3.75; 1.26 to 11.2) over a maximum follow-up period of 14 years (median 3.8 years; IQR, 2.0 to 6.1 years for +MWF and 4.6 years; IQR, 2.4 to 8.3 years for ‒MWF).

Separate analyses of +MWF and ‒MWF revealed that total mortality (aHR, 0.23; 0.07 to 0.75), total mortality or heart failure hospitalization (aHR, 0.32; 0.12 to 0.82), and total mortality or hospitalization for major adverse cardiac events (aHR, 0.30; 0.12 to 0.78) were lower after CRT-D than after CRT-P in NICM patients who were +MWF, but not in those who were −MWF.

These findings have significant implications for the choice of device therapy in NICM patients, according to researchers.

“Recent studies have cast doubt on the benefit of CRT-D versus CRT-P for patients with NICM. Left ventricular myocardial scar portends poor clinical outcomes,” they noted.

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Most Read Articles
Pearl Toh, 6 days ago
A study finds no evidence that using pharmaceutical aids alone for smoking cessation helps improve the chances of successful quitting despite promising results in previous randomized trials and routine prescription of such drugs to help quit smoking.
Elvira Manzano, 3 days ago
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