title: The risk of ventricular arrhythmias in a Dutch CRT population: CRT-defibrillator versus CRT-pacemaker.
abstract: BACKGROUND
  Patients eligible for cardiac resynchronisation therapy (CRT) have an indication for primary prophylactic implantable cardioverter defibrillator (ICD) therapy. However, response to CRT might influence processes involved in arrhythmogenesis and therefore change the necessity of ICD therapy in certain patients.
  
  
  METHODS
  In 202 CRT-defibrillator patients, the association between baseline variables, 6-month echocardiographic outcome (volume response: left ventricular end-systolic volume decrease < ≥15 % and left ventricular ejection fraction (LVEF) ≤ >35 %) and the risk of first appropriate ICD therapy was analysed retrospectively.
  
  
  RESULTS
  Fifty (25 %) patients received appropriate ICD therapy during a median follow-up of 37 (23-52) months. At baseline ischaemic cardiomyopathy (hazard ratio (HR) 2.0, p = 0.019) and a B-type natriuretic peptide level > 163 pmol/l (HR 3.8, p < 0.001) were significantly associated with the risk of appropriate ICD therapy. After 6 months, 105 (52 %) patients showed volume response and 51 (25 %) reached an LVEF > 35 %. Three (6 %) patients with an LVEF > 35 % received appropriate ICD therapy following echocardiography at ± 6 months compared with 43 patients (29 %) with an LVEF ≤ 35 % (p = 0.001). LVEF post-CRT was more strongly associated to the risk of ventricular arrhythmias than volume response (LVEF > 35 %, HR 0.23, p = 0.020).
  
  
  CONCLUSIONS
  Assessing the necessity of an ICD in patients eligible for CRT remains a challenge. Six months post-CRT an LVEF > 35 % identified patients at low risk of ventricular arrhythmias. LVEF might be used at the time of generator replacement to identify patients suitable for downgrading to a CRT-pacemaker.
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands. i.a.h.terhorst@umcutrecht.nl.
authors.forename: I A H
authors.initials: IA
authors.lastname: Ter Horst
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van 't Sant
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands.|Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: Wijers
authors.affiliation: Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Vos
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cramer
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Meine
keywords: Appropriate ICD; Cardiac resynchronisation therapy; Ventricular arrhythmias