The effect of classification of arrhythmic sudden cardiac death on the efficacy of cardiac resynchronization therapy in the CARE-HF study

TY - GEN

T1 - The effect of classification of arrhythmic sudden cardiac death on the efficacy of cardiac resynchronization therapy in the CARE-HF study

AU - Uretsky, B.

AU - Cleland, J.G.F.

AU - Freemantle, N.

AU - Daubert, J.C.

AU - Erdmann, E.

AU - Gras, D.

AU - Tavazzi, L.

AU - Thygesen, Kristian Anton

N1 - Udgave: http://www.escardio.org/knowledge/congresses/abol/presentation?id=39246

PY - 2006

Y1 - 2006

N2 - Topic(s):The definition of arrhythmic sudden cardiac death (SCD) differs widely among studies, which will affect the frequency with which it is ascribed as the cause of death. Cardiac resynchronization therapy (CRT) was reported to reduce SCD in the CARE-HF study. This could reflect a real effect of CRT on malignant arrhythmias or the methodology used to classify death. Accordingly, we investigated whether the way in which SCD was classified altered the conclusions of the study with respect to SCD.Methods: All patients classified as dying suddenly and unexpectedly as the mode of death without other cause were classified as SCD with the following levels of certainty: definite: witnessed SCD with documented arrhythmia; probable (witnessed)and possible (unwitnessed) SCD without documented arrhythmia.Results: The mode of death was sudden in 86 patients, of whom 71 were considered SCD: 10 definite, 29 probable, 32 possible. CRT decreased SCD in the overall cohort: Hazard ratio (HR) 0.53 [95% confidence interval (CI) 0.35 to 0.84; p=0.001]. CRT decreased SCD in definite plus probable SCD: HR 0.58 (0.31 to 1.10; p=0.09) and possible: HR 0.35 (0.16 to 0.76); p=0.008). The HR for reduction in the definite plus probable SCD group and the possible SCD group were not significantly different.Conclusion: CRT reduces SCD in patients with heart failure and markers of dyssynchrony. The observed effect is not dependent on the definition of SCD used. 

AB - Topic(s):The definition of arrhythmic sudden cardiac death (SCD) differs widely among studies, which will affect the frequency with which it is ascribed as the cause of death. Cardiac resynchronization therapy (CRT) was reported to reduce SCD in the CARE-HF study. This could reflect a real effect of CRT on malignant arrhythmias or the methodology used to classify death. Accordingly, we investigated whether the way in which SCD was classified altered the conclusions of the study with respect to SCD.Methods: All patients classified as dying suddenly and unexpectedly as the mode of death without other cause were classified as SCD with the following levels of certainty: definite: witnessed SCD with documented arrhythmia; probable (witnessed)and possible (unwitnessed) SCD without documented arrhythmia.Results: The mode of death was sudden in 86 patients, of whom 71 were considered SCD: 10 definite, 29 probable, 32 possible. CRT decreased SCD in the overall cohort: Hazard ratio (HR) 0.53 [95% confidence interval (CI) 0.35 to 0.84; p=0.001]. CRT decreased SCD in definite plus probable SCD: HR 0.58 (0.31 to 1.10; p=0.09) and possible: HR 0.35 (0.16 to 0.76); p=0.008). The HR for reduction in the definite plus probable SCD group and the possible SCD group were not significantly different.Conclusion: CRT reduces SCD in patients with heart failure and markers of dyssynchrony. The observed effect is not dependent on the definition of SCD used. 

M3 - Article in proceedings

BT - Ikke angivet

PB - European Society of Cardiology

T2 - World Congress of Cardiology 2006

Y2 - 2 September 2006 through 6 September 2006

ER -