Effects of smoking in patients treated with cardiac resynchronization therapy

Laura Perrotta, Brunilda Xhaferi, Marco Chiostri, Paolo Pieragnoli, Giuseppe Ricciardi, Luigi Di Biase, Andrea Natale, Ilaria Ricceri, Mazda Biria, Dhanunjay Lakkireddy, Alessandro Valleggi, Michele Emdin, Federica Michelotti, Giosuè Mascioli, Angela Pandozi, Massimo Santini, Luigi Padeletti

Research output: Contribution to journalArticlepeer-review


Smoking is associated with increased morbidity and mortality in cardiac patients. However, data on the prognostic impact of smoking in heart failure (HF) patients on cardiac resynchronization therapy with defibrillator (CRT-D) are absent. We investigated the effects of smoking on all-cause mortality and on a composite endpoint (all-cause death/appropriate device therapy), appropriate and inappropriate device therapy, in 649 patients with HF who underwent CRT-D between January 2003 and October 2011 in 6 Centers (4 in Italy and 2 in USA). 68 patients were current smokers, 396 previous-smokers (patients who had smoked in the past but who had quit before the CRT-D implant), and 185 had never smoked. The risk of each endpoint by smoking status was evaluated with both Kaplan-Meier and Cox proportional-hazard analysis. After adjusting for age, left ventricular ejection fraction, QRS width and ischemic etiology, both current and previous smoking were independent predictors of all-cause death [HR = 5.07 (95 % CI 2.68-9.58), p < 0.001 and HR = 2.43 (95 % CI 1.38-4.29), p = 0.002, respectively) and of composite endpoint [HR = 1.63 (1.04-2.56); p = 0.033 and HR = 1.46 (1.04-2.04) p = 0.027]. In addition, current smokers had a significantly higher rate of inappropriate device therapy compared to never smokers [HR = 21.74 (4.53-104.25), p = 0.005]. Our study indicates that in patients with HF who received a CRT-D device, current and previous smoking increase the event rate per person-time of death and of appropriate and inappropriate ICD therapy more than other known negative prognostic factors such as age, left ventricular dysfunction, prolonged QRS duration and ischemic etiology.

Original languageEnglish (US)
Pages (from-to)311-318
Number of pages8
JournalInternal and Emergency Medicine
Issue number3
StatePublished - Apr 2014
Externally publishedYes


  • Cardiac outcomes
  • Cardiac resynchronization therapy
  • Heart failure
  • Mortality
  • Smoking
  • Tachyarrhythmias

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine


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