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Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure: an updated meta-analysis

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Abstract

Previous studies of implantable cardiac resynchronization therapy plus defibrillator (CRT-D) therapy used for primary prevention of sudden cardiac death have suggested that CRT-D therapy is less effective in patients with mild heart failure and a wide QRS complex. However, the long-term benefits are variable. We performed a meta-analysis of randomized trials identified in systematic searches of MEDLINE, EMBASE, and the Cochrane Database. Three studies (3858 patients) with a mean follow-up of 66 months were included. Overall, CRT-D therapy was associated with significantly lower all-cause mortality than was implantable cardioverter defibrillator (ICD) therapy (OR, 0.78; 95 % CI, 0.63–0.96; P = 0.02; I 2 = 19 %). However, the risk of cardiac mortality was comparable between two groups (OR, 0.74; 95 % CI, 0.53–1.01; P = 0.06). CRT-D treatment was associated with a significantly lower risk of hospitalization for heart failure (OR, 0.67; 95 % CI, 0.50–0.89; P = 0.005; I 2 = 55 %). The composite outcome of all-cause mortality and hospitalization for heart failure was also markedly lower with CRT-D therapy than with ICD treatment alone (OR, 0.67; 95 % CI, 0.57–0.77; P < 0.0001; I 2 = 0 %). CRT-D therapy decreased the long-term risk of mortality and heart failure events in patients with mild heart failure with a wide QRS complex. However, long-term risk of cardiac mortality was similar between two groups. More randomized studies are needed to confirm these findings, especially in patients with NYHA class I heart failure or patients without LBBB.

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Acknowledgments

This work was financially supported by the grants from Natural Science Foundation of china (81373076) and Beijing Municipal Commission of Education (SQKM201210025010).

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Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China

    Wei-Ping Sun & Ling Zhang

  2. Beijing Luhe Hospital, Capital Medical University, Beijing, China

    Wei-Ping Sun, Chun-Lei Li, Jin-Cheng Guo, Li-Xin Zhang, Ran Liu & Hai-Bin Zhang

  3. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China

    Ling Zhang

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  1. Wei-Ping Sun
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Correspondence to Hai-Bin Zhang or Ling Zhang.

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Sun, WP., Li, CL., Guo, JC. et al. Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure: an updated meta-analysis. Heart Fail Rev 21, 447–453 (2016). https://doi.org/10.1007/s10741-016-9550-y

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