{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:42:14Z","timestamp":1789965734044,"version":"4.0.1"},"reference-count":28,"publisher":"BMJ","issue":"18","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,2,25]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In patients indicated for cardiac resynchronisation therapy (CRT), the choice between a CRT-pacemaker (CRT-P) versus defibrillator (CRT-D) remains controversial and indications in this setting have not been well delineated. Apart from inappropriate therapies, which are inherent to the presence of a defibrillator, whether adding defibrillator to CRT in the primary prevention setting impacts risk of other acute and late device-related complications has not been well studied and may bear relevance for device selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Observational multicentre European cohort study of 3008 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias, undergoing CRT implantation with (CRT-D, n=1785) or without (CRT-P, n=1223) defibrillator. Using propensity score and competing risk analyses, we assessed the risk of significant device-related complications requiring surgical reintervention. Inappropriate shocks were not considered except those due to lead malfunction requiring lead revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Acute complications occurred in 148 patients (4.9%), without significant difference between groups, even after considering potential confounders (OR=1.20, 95%\u2009CI 0.72 to 2.00, p=0.47). During a mean follow-up of 41.4\u00b129 months, late complications occurred in 475 patients, giving an annual incidence rate of 26 (95% CI 9 to 43) and 15 (95% CI 6 to 24) per 1000 patient-years in CRT-D and CRT-P patients, respectively. CRT-D was independently associated with increased occurrence of late complications (HR=1.68, 95%\u2009CI 1.27 to 2.23, p=0.001). In particular, when compared with CRT-P, CRT-D was associated with an increased risk of device-related infection (HR 2.10, 95%\u2009CI 1.18 to 3.45, p=0.004). Acute complications did not predict overall late complications, but predicted device-related infection (HR 2.85, 95%\u2009CI 1.71 to 4.56, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with CRT-P, CRT-D is associated with a similar risk of periprocedural complications but increased risk of long-term complications, mainly infection. This needs to be considered in the decision of implanting CRT with or without a defibrillator.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2017-312546","type":"journal-article","created":{"date-parts":[[2018,3,14]],"date-time":"2018-03-14T12:16:29Z","timestamp":1521029789000},"page":"1529-1535","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Device complications with addition of defibrillation to cardiac resynchronisation therapy for primary prevention"],"prefix":"10.1136","volume":"104","author":[{"given":"S\u00e9rgio","family":"Barra","sequence":"first","affiliation":[{"name":"Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Provid\u00eancia","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, Barts Health NHS Trust, London, 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Timone University Hospital, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Milliez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Caen University Hospital, Caen, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Da Costa","sequence":"additional","affiliation":[{"name":"Cardiology Department, St Etienne University Hospital, St Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Mondoly","sequence":"additional","affiliation":[{"name":"Cardiology Department, Toulouse University Hospital, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Gonzalez-Panizo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, 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