What Resulted in the Increase of Primary Prevention by Cardiac Resynchronization Therapy with Defibrillation (CRT-D) in Japan?

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MADIT-CRT trial and REVERSE trial recommended the implantation of CRT-D in patients with a relatively early phase of heart failure (HF) and electrocardiac disturbance (ED). The primary prevention by CRT-D has already increased for recent days in Japan. However, it is little known what caused an increase of implantation of CRT-D. Methods: We investigated 3267 patients (66±11 years old) with newly implanted CRT-D in data-base of JCDTR. The clinical characteristics were compared between primary and secondary prevention. Further, we investigated the transition of percentage of primary prevention, LVEF, QRS duration and NYHA functional class at the implantation for the latest 5 years. Results: Subjects were divided into two group, primary (n=2073; 63%) and secondary prevention (n=1194; 37%). The clinical characteristics of primary prevention were relatively elder, lower LVEF, higher NYHA functional class and higher degree of LV dyssynchrony. However, there was no significant difference in QRS duration. The percentage of primary prevention of CRT-D has significantly increased from 50% to 69%. But, the percentages of NYHA I/II, LVEF>35% and QRS duration <130 msec did not significantly change for 5 years in the primary prevention group. Conclusion: Though the primary prevention of CRT-D has increased for 5 years, this did not result from the increase of patients with a relatively early phase of HF and ED.