Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review

Sérgio Barra; Rui Providência; Kumar Narayanan; Serge Boveda; Rudolf Duehmke; Rodrigue Garcia; Francisco Leyva; Véronique Roger; Xavier Jouven; Sharad Agarwal; Wayne C Levy; Eloi Marijon

doi:10.1093/eurheartj/ehz773

Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review

Sérgio Barra
, Rui Providência
, Kumar Narayanan
, Serge Boveda
, Rudolf Duehmke
, Rodrigue Garcia
, Francisco Leyva
, Véronique Roger
, Xavier Jouven
, Sharad Agarwal
, Wayne C Levy
, Eloi Marijon

Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Papworth Rd, Cambridge CB2 0AY, UK
Cardiology Department, Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
Paris Cardiovascular Research Center (Inserm U970), Cardiovascular Epidemiology Unit, 56 Rue Leblanc, 75015 Paris, France
Cardiology Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076 TOULOUSE, 31300 Toulouse, France
Cardiology Department, James Paget University Hospital, Lowestoft Road Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK
Cardiology Department, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France
Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, 200 1st St SW, Rochester, MN 55905, USA
Paris Descartes University, 12 Rue de l'École de Médecine, 75006 Paris, France
Division of Cardiology, University of Washington, Seattle, WA, USA

Research output: Contribution to journal › Article › peer-review

43 Citations (SciVal)

Abstract

Aims:
While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years.

Methods and results:
Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use.

Conclusion:
Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably.

Original language	English
Pages (from-to)	1976–1986
Number of pages	11
Journal	European Heart Journal
Volume	41
Issue number	21
Early online date	21 Nov 2019
DOIs	https://doi.org/10.1093/eurheartj/ehz773
Publication status	Published - 1 Jun 2020

Keywords

Sudden death
Cardiac resynchronization
Implantable cardioverter-defibrillator
Biventricular pacemaker
Heart failure

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10.1093/eurheartj/ehz773

Cite this

Barra, S., Providência, R., Narayanan, K., Boveda, S., Duehmke, R., Garcia, R., Leyva, F., Roger, V., Jouven, X., Agarwal, S., Levy, W. C., & Marijon, E. (2020). Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review. European Heart Journal, 41(21), 1976–1986. https://doi.org/10.1093/eurheartj/ehz773

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title = "Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review",

abstract = "Aims: While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. Methods and results: Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. Conclusion: Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably. ",

keywords = "Sudden death, Cardiac resynchronization, Implantable cardioverter-defibrillator, Biventricular pacemaker, Heart failure",

author = "S{\'e}rgio Barra and Rui Provid{\^e}ncia and Kumar Narayanan and Serge Boveda and Rudolf Duehmke and Rodrigue Garcia and Francisco Leyva and V{\'e}ronique Roger and Xavier Jouven and Sharad Agarwal and Levy, \{Wayne C\} and Eloi Marijon",

year = "2020",

month = jun,

day = "1",

doi = "10.1093/eurheartj/ehz773",

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volume = "41",

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Barra, S, Providência, R, Narayanan, K, Boveda, S, Duehmke, R, Garcia, R, Leyva, F, Roger, V, Jouven, X, Agarwal, S, Levy, WC & Marijon, E 2020, 'Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review', European Heart Journal, vol. 41, no. 21, pp. 1976–1986. https://doi.org/10.1093/eurheartj/ehz773

TY - JOUR

T1 - Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy

T2 - a systematic review

AU - Barra, Sérgio

AU - Providência, Rui

AU - Narayanan, Kumar

AU - Boveda, Serge

AU - Duehmke, Rudolf

AU - Garcia, Rodrigue

AU - Leyva, Francisco

AU - Roger, Véronique

AU - Jouven, Xavier

AU - Agarwal, Sharad

AU - Levy, Wayne C

AU - Marijon, Eloi

PY - 2020/6/1

Y1 - 2020/6/1

N2 - Aims: While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. Methods and results: Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. Conclusion: Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably.

AB - Aims: While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. Methods and results: Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. Conclusion: Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably.

KW - Sudden death

KW - Cardiac resynchronization

KW - Implantable cardioverter-defibrillator

KW - Biventricular pacemaker

KW - Heart failure

UR - https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz773/5637310

U2 - 10.1093/eurheartj/ehz773

DO - 10.1093/eurheartj/ehz773

M3 - Article

SN - 0195-668X

VL - 41

SP - 1976

EP - 1986

JO - European Heart Journal

JF - European Heart Journal

IS - 21

ER -

Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review

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Keywords

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