Abstract | BACKGROUND: METHODS: We compared overall survival after appropriate shocks or anti- tachycardia pacing in 439 CRT- defibrillator recipients with left ventricular ejection fraction (LVEF) ≤35%, non- right bundle-branch block QRS pattern, and QRS duration >130 ms according to glomerular filtration rate (GFR) at implant, including 31 patients with GFR ≤30, 164 patients with GFR 31-60, and 244 patients with GFR >60. At least one shock occurred in 302 patients (24 with GFR ≤30, 102 with GFR 31-60, and 176 with GFR >60). Serial echocardiograms were also compared. RESULTS: Patients were followed 64 months (interquartile range [IQR]: 29-94) after implant, including 32 months (IQR: 12-61) after first therapy. Time to first therapy or shock was similar across GFR groups. However, survival after first therapy declined directly with declining GFR (P < .001), with median postshock survival of 90 days for GFR ≤30 (95% confidence of interval [CI]: 0-233), 612 days (95% CI: 365-859) for GFR 31-60, and 1672 days (95% CI: 1396-1948) for GFR >60. Declining GFR category, ischemic heart disease, diabetes, and increasing age were independently associated with increased postshock mortality. Echocardiographic response was similar across GFR groups and was not associated with post- therapy survival. CONCLUSIONS: Survival after appropriate tachyarrhythmia therapies, particularly shocks, is attenuated in patients with GFR ≤30. This raises concern over potential lack of survival benefit conferred by CRT- defibrillators versus CRT-pacemakers in this population.
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Authors | Evan C Adelstein, Samir Saba, Sandeep Jain, Norman C Wang |
Journal | Pacing and clinical electrophysiology : PACE
(Pacing Clin Electrophysiol)
Vol. 43
Issue 1
Pg. 78-86
(01 2020)
ISSN: 1540-8159 [Electronic] United States |
PMID | 31674681
(Publication Type: Journal Article)
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Copyright | © 2019 Wiley Periodicals, Inc. |
Topics |
- Aged
- Defibrillators, Implantable
- Echocardiography
- Female
- Humans
- Kidney Failure, Chronic
(complications, mortality)
- Male
- Middle Aged
- Pennsylvania
- Prospective Studies
- Registries
- Severity of Illness Index
- Survival Analysis
- Tachycardia
(mortality, therapy)
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