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European Heart Journal Advance Access originally published online on September 11, 2006
European Heart Journal 2006 27(22):2682-2688; doi:10.1093/eurheartj/ehl203
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effects of cardiac resynchronization therapy on overall mortality and mode of death: a meta-analysis of randomized controlled trials

Máximo Rivero-Ayerza*, Dominic A.M.J. Theuns, Hector M. Garcia-Garcia, Eric Boersma, Maarten Simoons and Luc J. Jordaens

Department of Cardiology, Thoraxcenter, Erasmu MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Received 27 March 2006; revised 6 July 2006; accepted 4 August 2006; online publish-ahead-of-print 11 September 2006.

* Corresponding author. Tel: +31 10 463 3991; fax: +31 10 463 4420. E-mail address: m.riveroayerza{at}erasmusmc.nl

See page 2617 for the editorial comment on this article (doi:10.1093/eurheartj/ehl310)

Aims Cardiac resynchronization therapy (CRT) has been shown to improve symptoms and exercise tolerance in patients with advanced heart failure (HF). However, studies were underpowered to address its effect on overall mortality. To evaluate whether CRT alone (without a combined defibrillator function) reduces overall mortality as compared with optimal pharmacological therapy, and how it affects the mode of death in patients with advanced HF.

Methods and results Public domain databases were systematically searched. Randomized controlled studies that evaluated the effects of CRT alone in patients with advanced HF and a depressed left ventricular systolic performance were selected for this analysis. Trials, which did not independently report data on CRT alone or had a follow-up period of less than 3 months, were excluded. Five studies were identified and analyzed. They included a total of 2371 patients, 1028 controls and 1343 CRT-treated patients. Pooled analysis demonstrated that CRT alone, as compared with optimal medical therapy, significantly reduced all-cause mortality by 29% [16.9 vs. 20.7%; odds ratio (OR), 0.71; 95% confidence interval (CI), 0.57–0.88] and mortality due to progressive HF by 38% (6.7 vs. 9.7%; OR, 0.62; 95% CI, 0.45–0.84). No effect on sudden cardiac death (SCD) was observed with CRT (6.4 vs. 5.9%; OR, 1.04; 95% CI, 0.73–1.22).

Conclusions CRT alone as compared with optimal medical therapy reduces all-cause mortality in patients with advanced HF. It predominantly reduces worsening HF mortality, not affecting SCD.

Key Words: Cardiac resynchronization therapy • Heart failure • Mortality • Mode of death


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