The benefits of adding a defibrillator to cardiac resynchronization therapy – systematic review and meta-analysis

Abstract Background There is an long-standing debate whether cardiac resynchronisation therapy-defibrillation (CRT-D) preferred over CRT-pacemaker (CRT-P). No randomised controlled trials have been designed to compare these treatments. However, several observational studies performed so far providing controversial results. Methods PubMed, CENTRAL and Embase until October 2021 were screened for comparing CRT-P CRT-D, focusing on all-cause mortality, cardiovascular sudden death, non-cardiac death. Conference abstracts excluded. Odds ratio with 95% confidence interval (CI) was calculated, data from the selected pooled using a random effect model (Mantel-Haenszel method, where more than 5 Hartung-Knapp adjustment). τ2 estimated by Paule-Mandel method CI calculated Q profile method. Statistical heterogeneity assessed Cochrane test I2 test. Results summarized Forest drapery plots. Altogether 20 retrospective (69,124 patients) included (CRT-P: 37,461, CRT-D: 31,663). CRT-D superior regarding mortality in multivariate analysis (aHR: 0.79; CI: 0.69–0.88; p<0.01). Based propensity matched (25,040 patients; 12,520 CRT-P, CRT-D) showed significantly better survival compared (HR: 0.83; 0.79–0.87; p<0.001). Three (47,846 patients, CRT-P: 27,344, 20,502) between CRT-P. Univariate lower rate of patients implanted device 0.61; 0.50–0.73; p=0.002). (4,623 patients. 2,518, 2,105) reported heart failure associated decreased 0.68; 0.41–0.95; p=0.008). Five (6,434 3,475, 2,959) analyzed univariate 0.33; 0.28–0.89; p=0.03). (48,770 28,398, 20,372) 0.58; 0.55–0.60; Conclusion Our meta-analysis demonstrated that had risk based those used score matching. death due articles coming selection bias CRT-D/CRT-P implantation, this question requires further analysis. Funding Acknowledgement Type funding sources: Other. Main source(s): The research presented here, carried out Semmelweis University supported 250+ Excellence Scholarship (EFOP-3.6.3-VEKOP-16-2017-00009)as well as Centre Translational Medicine, University. This work financed Thematic Programme (2020-4.1.1.-TKP2020) Ministry Innovation Technology Hungary, within framework Therapeutic Development Bioimaging thematic programmes - I agree information can be anonymised then statistical purposes only