Cardiac Resynchronization Therapy (CRT) with or without Defibrillation in Patients with Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-analysis

Author:

Patel Divyang1,Kumar Anirudh1ORCID,Black-Maier Eric2,Morgan Rebecca L.3ORCID,Trulock Kevin1,Wilner Bryan1,Nemer David1ORCID,Donnellan Eoin1ORCID,Tarakji Khaldoun G.1ORCID,Cantillon Daniel J.1,Varma Niraj1ORCID,Saba Samir F.4ORCID,Al-Khatib Sana M.2ORCID,Wilkoff Bruce L.1ORCID,Rickard John W.1ORCID

Affiliation:

1. Heart and Vascular Institute Cleveland Clinic, Cleveland, OH

2. Duke Clinical Research Institute, Duke University Medical System, Durham, NC

3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

4. The Heart and Vascular Institute & Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

Abstract

Background - Cardiac resynchronization therapy (CRT) represents a major medical advance in patients with heart failure (HF) with electrical dysschrony to improve symptoms, reduce hospitalization, and increase survival both in the presence and absence of implantable-cardioverter defibrillator (ICD) therapy. However, among CRT-eligible patients with non-ischemic cardiomyopathy (NICM), the benefit of defibrillator therapy in addition to CRT remains unclear. A systematic review and meta-analysis comparing outcomes of patients with NICM and HF who underwent CRT with ICD (CRT-D) vs. CRT only (CRT-P) was therefore performed. Methods - A literature search from inception through February 2020 was conducted in PubMed and Cochrane Review Databases for all studies reporting outcomes of CRT-D versus CRT-P in CRT-eligible patients with NICM. Studies reporting non-stratified outcomes including patients with ischemic cardiomyopathy were excluded. The primary end point of interest was all-cause mortality. A random effects model using hazards ratio (HR) was utilized to calculate a cumulative HR for all-cause mortality. The GRADE approach assessed the certainty of evidence across outcomes. Results - Of a total of 1,478 potential citations, the search yielded eight citations that met inclusion and exclusion criteria. There was one randomized controlled trial which included a sub-group of 645 CRT-eligible NICM patients (322 with CRT-D and 323 with CRT-P). Seven observational studies representing 9,944 CRT-eligible patients with NICM (6,865 CRT-D implantation and 3,079 with CRT-P) were included in a pooled meta-analysis. The cumulative adjusted HR for all-cause mortality for CRT-D versus CRT-P was 0.92 (95% CI; 0.83, 1.03); I 2 = 0 though with low certainty of evidence. There may be little difference in infection and cardiac mortality between CRT-D versus CRT-P devices (HR: 0.82; 95% CI: 0.29, 2.20 moderate certainty of evidence, and HR: 0.68; 95% CI: 0.37, 1.25, low certainty of evidence, respectively). Conclusions - In this meta-analysis, the addition of defibrillator therapy was not significantly associated with a reduction in all-cause mortality in CRT-eligible patients with NICM.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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