Author + information
- Anne-Christine Huth Ruwald,
- Grzegorz Pietrasik,
- Ilan Goldenberg,
- Christian Jons,
- Valentina Kutyifa,
- Scott McNitt,
- Wojciech Zareba and
- Arthur Moss
There are limited data regarding the benefit of cardiac resynchronization therapy with a defibrillator (CRT-D) in heart failure (HF) patients who develop atrial tachyarrhytmias (AT). We aimed to investigate the effect of AT on HF or death in CRT-D vs. implantable cardioverter defibrillator (ICD) treatment in patients with mild HF enrolled in MADIT-CRT.
The benefit of CRT-D, in reducing the risk of HF or death in MADIT-CRT, was evaluated by the presence of a history of AT at baseline and time-dependent development of AT during the trial. Arrhythmias were assessed using adjudicated device interrogations.
The overall beneficial effect of CRT-D vs. ICD on the risk of HF or death was not significantly different between patients with or without a history of AT (HR = 0.71 and 0.59, respectively; p for interaction=0.47) Among patients who developed AT during the trial, CRT-D was associated with a significant 51% reduction in the risk of HF or death compared with ICD-only therapy (HR=0.49, p=0.01), similar to the effect of the device among patients who did not develop AT (HR=0.62; p-value for AT-by-treatment interaction = 0.50) (Figure). Consistent results were shown when the benefit of CRT-D was assessed among patients who developed in-trial paroxysmal atrial fibrillation/flutter (HR=0.39; p=0.037).
In MADIT-CRT, the clinical benefit of cardiac resynchronization therapy was not attenuated following the development of AT.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: Devices II – Improving Outcomes in Patients with Implantable Devices: Tweaking the Well-Functioning Machine
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1190-45
- 2013 American College of Cardiology Foundation