Impact of implantable defibrillators and resynchronization therapy on outcome in patients with left ventricular dysfunction--a meta-analysis.

Abstract

BACKGROUND:

The clinical benefits of cardiac resynchronization therapy (CRT) and primary prophylactic implantable cardioverter defibrillator (ICD) in patients with left ventricular systolic dysfunction (LVSD) are debated.

OBJECTIVE:

To evaluate by a meta-analysis the effect of CRT and prophylactic ICD therapy in patients with LVSD.

METHODS:

Eligible trials evaluating the effect of CRT vs. no-CRT, ICD vs. no-ICD and adding ICD to CRT vs. no-ICD were selected and meta-analyzed. The outcomes were: all cause mortality, cardiac mortality, hospitalization for heart failure and change in exercise tolerance and New York Heart Association class.

RESULTS:

Implantation of CRT reduced all cause mortality odds ratio (OR) = 0.73 (0.60-0.89) p = 0.002 and hospitalization for heart failure OR = 0.60 (0.45, 0.80) p = 0.001, increased peak oxygen consumption by 1.77 (0.32-3.22) ml/kg/min p = 0.017 and improved New York Heart Association class by at least one class with OR = 1.52 (1.30, 1.77) p < 0.0001. Implantation of ICD reduced all-cause mortality OR = 0.75 (0.59-0.96) p = 0.025 and cardiac mortality OR = 0.63 (0.48, 0.82) p = 0.001. Adding ICD to CRT reduced all cause mortality OR = 0.69 (0.53-0.91) p = 0.008.

CONCLUSION:

Selective patients with LVSD benefit from CRT, ICD or both. Further investigations are necessary to clarify which patients benefit most from a single or combined device implantation.

• Authors: Jawdat Abdulla, Jens Haarbo, Lars Køber, Christian Torp-Pedersen
• Journal: Cardiology (Cardiology) Vol. 106 Issue 4 Pg. 249-55 ( 2006) ISSN: 0008-6312 [Print] Switzerland
• PMID: 16707863 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: 2006 S. Karger AG, Basel

Topics

• Defibrillators, Implantable
• Humans
• Pacemaker, Artificial
• Ventricular Dysfunction, Left (mortality, therapy)