Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy: A Systematic Review and Meta-Analysis
| العنوان: | Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy: A Systematic Review and Meta-Analysis |
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| المؤلفون: | Divyang Patel, Sana M. Al-Khatib, Bruce L. Wilkoff, Kevin Trulock, Anirudh Kumar, Samir Saba, Eric Black-Maier, Daniel J. Cantillon, Niraj Varma, John Rickard, Rebecca L. Morgan, David M. Nemer, Khaldoun G. Tarakji, Eoin Donnellan, Bryan Wilner |
| المصدر: | Circulation: Arrhythmia and Electrophysiology. 14 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Pacemaker, Artificial, medicine.medical_specialty, genetic structures, Defibrillation, medicine.medical_treatment, Cardiac resynchronization therapy, 030204 cardiovascular system & hematology, Cardiac Resynchronization Therapy, 03 medical and health sciences, 0302 clinical medicine, Text mining, Physiology (medical), Internal medicine, medicine, Humans, In patient, cardiovascular diseases, 030212 general & internal medicine, Heart Failure, business.industry, medicine.disease, Defibrillators, Implantable, Treatment Outcome, Nonischemic cardiomyopathy, Heart failure, Meta-analysis, cardiovascular system, Cardiology, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business |
| الوصف: | Background: Cardiac resynchronization therapy (CRT) represents a major medical advance in patients with heart failure with electrical dyssynchrony to improve symptoms, reduce hospitalization, and increase survival both in the presence and absence of implantable cardioverter-defibrillator therapy. However, among CRT-eligible patients with nonischemic cardiomyopathy (NICM), the benefit of defibrillator therapy in addition to CRT remains unclear. A systematic review and meta-analysis comparing outcomes of patients with NICM and heart failure who underwent CRT with implantable cardioverter-defibrillator (CRT-D) versus CRT-pacemaker only (CRT-P) was, therefore, performed. Methods: A literature search from inception through February 2020 was conducted in PubMed and Cochrane Review Databases for all studies reporting outcomes of CRT-D versus CRT-P in CRT-eligible patients with NICM. Studies reporting nonstratified outcomes, including patients with ischemic cardiomyopathy, were excluded. The primary end point of interest was all-cause mortality. A random-effects model using hazards ratio (HR) was used to calculate a cumulative HR for all-cause mortality. The Grading of Recommendations Assessment, Development, and Evaluation approach assessed the certainty of evidence across outcomes. Results: Of a total of 1478 potential citations, the search yielded 8 citations that met inclusion and exclusion criteria. There was one randomized controlled trial which included a subgroup of 645 CRT-eligible patients with NICM (322 with CRT-D and 323 with CRT-P). Seven observational studies representing 9944 CRT-eligible patients with NICM (6865 CRT-D implantation and 3079 with CRT-P) were included in a pooled meta-analysis. The cumulative adjusted HR for all-cause mortality for CRT-D versus CRT-P was 0.92 (95% CI, 0.83–1.03); I 2 =0 though with low certainty of evidence. There may be little difference in infection and cardiac mortality between CRT-D versus CRT-P devices (HR, 0.82 [95% CI, 0.29–2.20] moderate certainty of evidence and HR, 0.68 [95% CI, 0.37–1.25], low certainty of evidence, respectively). Conclusions: In this meta-analysis, the addition of defibrillator therapy was not significantly associated with a reduction in all-cause mortality in CRT-eligible patients with NICM. |
| تدمد: | 1941-3084 1941-3149 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::379ae9ea425a839c9ff80f392c3ba9c1 https://doi.org/10.1161/circep.120.008991 |
| رقم الأكسشن: | edsair.doi.dedup.....379ae9ea425a839c9ff80f392c3ba9c1 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19413084 19413149 |
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