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Effect of left ventricular ejection fraction and QRS duration on the survival benefit of implantable cardioverter-defibrillators: meta-analysis of primary prevention trials.
MedLine Citation:
PMID:  23107652     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Implantable cardioverter-defibrillators (ICD) are recommended for the primary prevention of sudden cardiac death in patients with left ventricular dysfunction but it is unclear whether treatment benefits are diminished in patients with very low baseline left ventricular ejection fraction (LVEF) (<25%) or increased in those with prolonged QRS duration (>120 msec). OBJECTIVE: To study the effects of very low LVEF and prolonged QRS duration on the mortality benefits of ICD therapy. METHODS: We performed a meta-analysis of primary prevention randomized controlled trials comparing ICD and standard medical therapy. All-cause mortality hazard ratios in subgroups according to thresholds of 25% for LVEF and 120 msec for QRS duration were extracted from published reports or contributed by trial investigators and synthesized. RESULTS: There was no significant difference of ICD effectiveness in LVEF subgroups of 25-35% (random effects HR 0.81, 95% CI 0.70-0.94) versus <25% (HR 0.71, 95% CI 0.55-0.93). Results were similar also in the narrow and wide QRS subgroups (HR 0.78, 95% CI 0.68-0.90 and 0.70, 0.51-0.95, respectively). Within the LVEF<25% and wide QRS subgroups, there was large heterogeneity driven by the DINAMIT trial that included early post-myocardial infarction patients and its results (HR 1.49, 95% CI 0.84-2.68, and 1.51, 0.83-2.83, respectively) differed significantly from other trials (p=0.008 and p=0.01, respectively). CONCLUSION: LVEF values and QRS duration do not appear to directly modify the survival benefit of ICD in patients with baseline LVEF<35%. However, patients with a recent myocardial infarction do not benefit from ICD, especially when they have LVEF <25% and/or wide QRS.
Authors:
Demosthenes G Katritsis; Konstantinos C Siontis; J Thomas Bigger; Alan H Kadish; Richard Steinman; Wojciech Zareba; George C M Siontis; Gust H Bardy; John P A Ioannidis
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-26
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
Department of Cardiology, Athens Euroclinic, Athens, Greece. Electronic address: dkatritsis@euroclinic.gr.
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