Predictors for ventricular arrhythmia
In the present study we identified 4 factors that were associated with
increased risk of VTA, including BUN>25mg/dl,
EF<20%, prior NSVT, and female gender. Reduced EF and prior
NSVT reflect substrate and vulnerability to sustained VTA in patients
with CRT-D,19,20 while elevated BUN is correlated with
diuretic use, and may therefore be a marker of more advanced HF rather
than an indicator of renal dysfunction, as creatinine and eGFR did not
enter the final prediction model.
Several previous publications have suggested that women may respond
better to CRT with subsequent lower mortality than
men.21,22 Our study suggests that among patients
without LBBB, the effect of sex may be different, and that non-LBBB
women may experience increased VTA risk with CRT-D. These data are
consistent with our prior findings from the long-term follow-up of
MADIT-CRT, in which we have shown that the pronounced benefit of CRT for
the endpoint of all-cause mortality among women was restricted to those
with LBBB, whereas CRT-D was associated with a trend to a mortality risk
increase among women without LBBB.