Author + information
- Valentina Kutyifa,
- Blanca Quesada,
- Helmut Klein,
- Yitschak Biton,
- Scott McNitt,
- Bronislava Polonsky,
- Wojciech Zareba,
- Arthur Moss and
- Aurelio Quesada
Patients with NYHA class II derive benefit from cardiac-resynchronization therapy (CRT), however, data on CRT effects in asymptomatic heart failure (NYHA class I) are limited. Patients with NYHA class I are not currently indicated for CRT.
We assessed the effects of CRT-D vs. ICD on long-term outcomes of heart failure (HF) or death in NYHA class I patients (n=265) with ischemic heart disease and severe left ventricular systolic dysfunction (LVEF≤30%) vs. NYHA II (n=734), analyzed by left bundle branch block (LBBB) status, enrolled in the MADIT-CRT trial.
Patients with NYHA I with LBBB had a lower risk of HF or death with CRT-D as compared to ICD-only (HR=0.58, 95% CI: 0.33-1.01, p=0.052), which was mainly driven by reduction of HF events (HR=0.39, 95% CI: 0.21-0.75, p=0.005). In NYHA class II patients with LBBB, there was a significant reduction in HF or death (HR=0.49, 95% CI: 0.36-0.68, p=0<0.001), and a significant reduction in HF events with CRT-D vs. ICD-only (HR=0.39, 95% CI: 0.27-0.58, P<0.001), similar to the NYHA class I patients (Figure). Patients with non-LBBB did not have a lower risk of long-term HF or death with CRT-D vs. ICD alone with either NYHA class II or NYHA class I.
In MADIT-CRT, asymptomatic HF patients derived significant clinical benefit from CRT-D vs. ICD with reductions in long-term HF events. Asymptomatic HF patients with severe left ventricular dysfunction could be potentially considered for CRT implantation to reduce morbidity.
Poster Hall, Hall A/B
Sunday, March 11, 2018, 3:45 p.m.-4:30 p.m.
Session Title: Biventricular and His Bundle Pacing
Abstract Category: 05. Arrhythmias and Clinical EP: Devices
Presentation Number: 1234-002
- 2018 American College of Cardiology Foundation