Cardiac resynchronization therapy in continuous flow left ventricular assist device recipients: A systematic review and meta-analysis from ELECTRAM investigators

Authors

Kuldeep Shah, Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
Vallabh Karpe, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA, United States
Mohit Turagam, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
Mahek Shah, Division of Cardiology, Section of Heart Failure and Transplantation Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, United StatesFollow
Andrea Natale, Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, United States
Rakesh Gopinathannair, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, KS, United States
Dhanunjaya Lakkireddy, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, KS, United States
Jalaj Garg, Medical College of Wisconsin, Cardiac Arrhythmia Service, Milwaukee, WI, United States; Division of Cardiology, Cardiac Arrhythmia Service Medical, College of Wisconsin, 10000 Innovation Drive, Milwaukee, WI 53226, United States

Document Type

Article

Publication Date

1-1-2021

Comments

This article is the author's final published version in Journal of Atrial Fibrillation, Volume 13, Issue 4, January 2021, Pages 16-22.

The published version is available at https://doi.org/10.4022/JAFIB.2441

Copyright © 2020 CardioFront LLC. All rights reserved.

Abstract

Introduction: Whether cardiac resynchronization therapy (CRT) continues to augment left ventricular remodeling in patients with the continuous-flow left ventricular assist device (cf-LVAD) remains unclear. Methods: We performed a systematic review and meta-analysis of all clinical studies examining the role of continued CRT in end-stage heart failure patients with cf-LVAD reporting all-cause mortality, ventricular arrhythmias, and ICD shocks. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data. Results: Eight studies (7 retrospective and 1 randomized) with a total of 1,208 unique patients met inclusion criteria. There was no difference in all-cause mortality (RR 1.08, 95% CI 0.86-1.35, p = 0.51, I2=0%), all-cause hospitalization (RR 1.01, 95% CI 0.76-1.34, p = 0.95, I2=11%), ventricular arrhythmias (RR 1.08, 95% CI 0.83-1.39, p = 0.58, I2 =50%) and ICD shocks (RR 0.87, 95% CI 0.57-1.33, p = 0.52, I2 =65%) comparing CRT versus non-CRT. Subgroup analysis demonstrated significant reduction in ventricular arrhythmias (RR 0.76, 95% CI 0.64-0.90, p = 0.001) and ICD shocks (RR 0.65, 95% CI 0.44-0.97, p = 0.04) in "CRT on" group versus "CRT off" group. Conclusion: CRT was not associated with a reduction in all-cause mortality or increased risk of ventricular arrhythmias and ICD shocks compared to non-CRT in cf-LVAD patients. It remains to be determined which subgroup of cf-LVAD patients benefit from CRT.The findings of our study are intriguing, and therefore,larger studies in a randomized prospective manner should be undertaken to address this specifically.

Recommended Citation

Shah, Kuldeep; Karpe, Vallabh; Turagam, Mohit; Shah, Mahek; Natale, Andrea; Gopinathannair, Rakesh; Lakkireddy, Dhanunjaya; and Garg, Jalaj, "Cardiac resynchronization therapy in continuous flow left ventricular assist device recipients: A systematic review and meta-analysis from ELECTRAM investigators" (2021). Division of Cardiology Faculty Papers. Paper 78.
https://jdc.jefferson.edu/cardiologyfp/78

Creative Commons License

This work is licensed under a Creative Commons Attribution 3.0 License.

Language

English