Cardiac resynchronization therapy with a defibrillator in non-ischemic and ischemic patients for primary and secondary prevention of sudden cardiac death: Analysis of the Japan cardiac device treatment registry database

Hisashi Yokoshiki; Akihiko Shimizu; Takeshi Mitsuhashi; Kohei Ishibashi; Tomoyuki Kabutoya; Yasuhiro Yoshiga; Yusuke Kondo; Haruhiko Abe; Wataru Shimizu; Members of the Implantable Cardioverter‐Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society

doi:10.1002/joa3.12916

Cardiac resynchronization therapy with a defibrillator in non-ischemic and ischemic patients for primary and secondary prevention of sudden cardiac death: Analysis of the Japan cardiac device treatment registry database

J Arrhythm. 2023 Aug 24;39(5):757-765. doi: 10.1002/joa3.12916. eCollection 2023 Oct.

Authors

Hisashi Yokoshiki¹, Akihiko Shimizu², Takeshi Mitsuhashi³, Kohei Ishibashi⁴, Tomoyuki Kabutoya⁵, Yasuhiro Yoshiga⁶, Yusuke Kondo⁷, Haruhiko Abe⁸, Wataru Shimizu⁹; Members of the Implantable Cardioverter‐Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society

Affiliations

¹ Department of Cardiovascular Medicine Sapporo City General Hospital Sapporo Japan.
² UBE Kohsan Central Hospital Ube Japan.
³ Department of Cardiovascular Medicine Hoshi General Hospital Koriyama Japan.
⁴ Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan.
⁵ Division of Cardiovascular Medicine, Department of Medicine Jichi Medical University School of Medicine Shimotsuke Japan.
⁶ Division of Cardiology, Department of Medicine and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan.
⁷ Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan.
⁸ Department of Heart Rhythm Management University of Occupational and Environmental Health Kitakyushu Japan.
⁹ Department of Cardiovascular Medicine Nippon Medical School Bunkyo City Japan.

Abstract

Background: Panoramic studies in patients with cardiac resynchronization therapy with a defibrillator (CRT-D) focusing on the etiology and indication are scarce. Besides, a controversy exists regarding requirement of a defibrillator in non-ischemic patients for primary prevention with CRT.

Methods: Annual trends of de novo CRT-D implantations from 2011 to 2020 and outcomes of those between January 2011 and August 2015 were analyzed from the Japan cardiac device treatment registry (JCDTR) and New JCDTR database.

Results: From 2011 to 2020, 8062 CRT-D recipients were registered, whose dominant indication was primary prevention of sudden cardiac death with a steady rate of about 70%. There was no significant temporal change of the proportion of non-ischemic patients being about 70% and 65% for primary and secondary prevention, respectively. Non-ischemic patients for primary prevention were associated with increased odds of appropriate ICD therapy [adjusted hazard ratio (aHR): 1.66; 95% confidence interval (CI): 1.01-2.75; p = .047] and reduced odds of any death (aHR: 0.66; 95% CI: 0.44-0.99; p = .046) as compared to ischemic patients.

Conclusions: Proportion of non-ischemic etiology was much higher than that of ischemic one in the CRT-D cohort. Based on the higher odds of appropriate ICD therapy, non-ischemic patients for primary prevention appear to be prudently selected in Japan.

Keywords: cardiac resynchronization therapy with a defibrillator (CRT‐D); implantable cardioverter‐defibrillator (ICD); non‐ischemic; primary prevention; ventricular fibrillation (VF); ventricular tachycardia (VT).