Effectiveness of CRT-D versus ICD on Prevention of Electrical Storm: Big Data from the USA

Abstract

Patients with implantable cardioverter-defibrillator (ICD) are at the risk of electrical storm (ES) occurrence associated with mortality and poor quality of life. Cardiac resynchronization therapy with defibrillator (CRT-D) minimizes inappropriate ICD shocks. However, limited reports exist on the impact of CRT-D versus traditional ICD on ES occurrences in real-life cohorts. We evaluated the implanted-device characteristics associated with ES events in a large data based on daily stored device-summaries obtained from remote monitoring data in US. Between 2004 and 2016, 19,935 US patients were implanted. Survival analyses with Cox regression for device-shock therapy were performed between patients who experienced at least one ES and those without ES. CRT-D devices (bi-ventricular) were implanted in 5522 (28%) patients during this period, and their ES events over time were compared to ICD recipients implanted with RV lead. Primary endpoint was the first ES event. ES occurred with the rate of 7.26% for all patients during the period. Cox regression analyses revealed significantly an increase risk in ES occurrences (the p-value < 0.05 and hazard ratio >> 1) with shock therapy. CRT-D implant led to lower ES risk comparing with patients received traditional ICD (RV only).