Journal Article

Long-Term Outcomes of Resynchronization–Defibrillation for Heart Failure

Sterns, Laurence D., Parkash, Ratika, Wells, George, Thibault, Bernard, Manlucu, Jaimie, Talajic, Mario, Rouleau, Jean, McKinlay, Stuart, Healey, Jeff S., Exner, Derek V., Redpath, Calum J., Mokhtar, Ahmed, Sumner, Glen, Mondesert, Blandine, Sapp, John L., Khan, Habib, McCarron, C. Elizabeth, Tang, Anthony S. L., Sivakumaran, Soori, Lam, Nhat Hung N., Kimber, Shane

2024

Overview

The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter-defibrillators (ICDs). However, the effect of CRT on long-term survival is not known. We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device. The trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P = 0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group. Among patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up. (RAFT ClinicalTrials.gov number, NCT00251251.).

• Publisher: Massachusetts Medical Society
• Subject: Arrhythmias / Cardiac arrhythmia / Cardiac Resynchronization Therapy / Cardiology / Cardiology General / Congestive heart failure / Death / Decision making / Defibrillators / Defibrillators, Implantable / Ejection fraction / Electrocardiography / Follow-Up Studies / Heart Failure / Heart Failure - mortality / Heart Failure - physiopathology / Heart Failure - therapy / Heart transplantation / Heart transplants / Humans / Kaplan-Meier Estimate / Mortality / Pacemakers / Patients / Statistical analysis / Stroke Volume / Survival / Survival analysis / Time Factors / Treatment Outcome / Ventricle / Ventricular Function, Left