The rate of cardiac resynchronization therapy defibrillator (CRT-D) implantations that were guideline-concordant increased following an October 2012 update regarding patient selection in the device-based therapy guideline, according to a study published June 19 in JAMA Cardiology.

Amneet Sandhu, MD, MSc, used data from ACC's ICD Registry to evaluate the changing state of CRT-D use in the U.S. following the release of the 2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. The researchers looked at CRT-D trends, factors associated with guideline-concordant and guideline-discordant implantation, and hospital-based variations in guideline-based CRT-D implantation.

The researchers looked at 88,923 patients who received initial CRT-D implantation between January 2012 and December 2015 at 1,710 hospitals. Throughout the study period, 73,859 implantations (83.1 percent) were concordant with the 2012 guideline at the time of the procedure. Guideline-discordant use was concentrated in 565 hospitals, accounting for more than 70 percent of guideline-discordant cases (10,545). Among patients who received guideline-concordant devices, 61,028 (82.6 percent) had left bundle branch block. Patients who received guideline-discordant devices were more likely than those receiving guideline-concordant implants to have underlying right bundle branch block (23.9 percent vs. 10.1 percent) or nonspecific intraventricular conduction delay (22.2 percent vs. 6.5 percent).

According to the researchers, the study's findings "demonstrate an increase in guideline-concordant patient selection for CRT-D implantation during the study period." The concentration of guideline-discordant implants in certain hospitals suggests "continued opportunities for improvement in the use of CRT-D to target those most likely to benefit from this therapy," they conclude.

Keywords: Bundle-Branch Block, Patient Selection, Cardiac Resynchronization Therapy, Arrhythmias, Cardiac, Registries, National Cardiovascular Data Registries, ICD Registry, Defibrillators, Implantable

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