{"id":"0c6911c84d42","type":"article","url":"https://hartvaat.nl/2018/03/01/doodsoorzaken-bij-crt-met-en-zonder-defibrillator-meta-analyse/","title":"Doodsoorzaken bij CRT met en zonder defibrillator: meta-analyse","title_en":"Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","icd-implantatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/eux094","source_url":"https://doi.org/10.1093/europace/eux094","authors":["Sérgio Barra","Rui Providência","Rudolf Duehmke","Serge Boveda","David Begley","Andrew Grace","Kumar Narayanan","Anthony Tang","Eloi Marijon","Sharad Agarwal"],"significance":6,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of cause-specific mortality in CRT-P versus CRT-D patients provided data relevant to the ongoing debate about whether the defibrillator component adds meaningful survival benefit on top of resynchronization therapy.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse van doodsoorzaken bij patiënten met CRT-P versus CRT-D. Relevant voor de keuze tussen resynchronisatie met of zonder ICD-component.","abstract_original":"AIMS: The additional benefit of a defibrillator in cardiac resynchronization therapy (CRT) patients is a matter of debate. Cause-of-death analysis in a CRT population has been recently proposed as a useful approach to gain insight into this problem. We performed a systematic review and meta-analysis looking at cause of death in studies involving CRT subjects with (CRT-D) or without (CRT-P) a defibrillator. METHODS AND RESULTS: Literature search performed from inception to 31 March 2016 for relevant studies. Proportional and conventional meta-analyses were performed to obtain and compare causes of death in CRT-D vs. CRT-P patients, including sudden cardiac death (SCD), all-cause mortality, heart failure, cardiovascular, and non-cardiovascular mortalities. The systematic review included a total of 44 studies and 18 874 patients (13 248 receiving CRT-D and 5626 receiving CRT-P), representing 48 504 patient-years of follow-up. CRT-D recipients were younger, more often male, had lower NYHA class, less atrial fibrillation, more ischaemic heart disease and were more often on beta-blockers than those receiving CRT-P. There were an additional 42 deaths per 1000 patient-years in the CRT-P group compared with CRT-D (97 ± 9, 95% CI 79-115 vs. 55 ± 5, 95% CI 44-65, respectively), of which 35.7% were due to SCD (20 ± 2, 95% CI 15-24 vs. 5 ± 1, 95% CI 3-6) and the remaining 64.3% due to non-SCD. Of all deaths reported in CRT-D and CRT-P patients, 9.1% and 20.6% were due to SCD, respectively. The extent of SCD in CRT-P patients significantly increased in studies with higher percentage of males, ischaemic cardiomyopathy and NYHA class 3. CONCLUSION: Overall, compared with CRT-D patients, unadjusted mortality rate was almost two-fold higher in CRT-P recipients, with SCD representing one third of the excess mortality. Rate of SCD was significantly higher in certain subgroups (males, ischaemic cardiomyopathy, NYHA class 3), where a CRT-D may be of more pronounced benefit. This deserves further focused investigation."}