Author + information
- Received September 30, 2010
- Revision received February 20, 2011
- Accepted March 8, 2011
- Published online June 14, 2011.
- Alon Barsheshet, MD⁎,⁎ (, )
- Paul J. Wang, MD†,
- Arthur J. Moss, MD⁎,
- Scott D. Solomon, MD‡,
- Amin Al-Ahmad, MD†,
- Scott McNitt, MS⁎,
- Elyse Foster, MD§,
- David T. Huang, MD⁎,
- Helmut U. Klein, MD⁎,
- Wojciech Zareba, MD, PhD⁎,
- Michael Eldar, MD∥ and
- Ilan Goldenberg, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Alon Barsheshet, Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, New York 14642
Objectives We aimed to evaluate the relationship between echocardiographic response to cardiac resynchronization therapy (CRT) and the risk of subsequent ventricular tachyarrhythmias (VTAs).
Background Current data regarding the effect of CRT on the risk of VTA are limited and conflicting.
Methods The risk of a first appropriate implantable cardioverter-defibrillator (ICD) therapy for VTA (including ventricular tachycardia, ventricular fibrillation, and ventricular flutter) was compared between high- and low-echocardiographic responders to CRT defibrillator (CRT-D) therapy (defined as ≥25% and <25% reductions, respectively, in left ventricular end-systolic volume [LVESV] at 1 year compared with baseline) and ICD-only patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy).
Results The cumulative probability of a first VTA at 2 years after assessment of echocardiographic response was highest among low responders to CRT-D (28%), intermediate among ICD-only patients (21%), and lowest among high responders to CRT-D (12%), with p < 0.001 for the overall difference during follow-up. Multivariate analysis showed that high responders to CRT-D experienced a significant 55% reduction in the risk of VTA compared with ICD-only patients (p < 0.001), whereas the risk of VTA was not significantly different between low responders and ICD-only patients (hazard ratio [HR]: 1.26; p = 0.21). Consistently, assessment of response to CRT-D as a continuous measure showed that incremental 10% reductions in left ventricular end-systolic volume were associated with corresponding reductions in the risk of subsequent VTA (HR: 0.80; p < 0.001), VTA/death (HR: 0.79; p < 0.001), ventricular tachycardia (HR: 0.80; p < 0.001), and ventricular fibrillation/ventricular flutter (HR: 0.75; p = 0.044).
Conclusions In patients with left ventricular dysfunction enrolled in the MADIT-CRT trial, reverse remodeling was associated with a significant reduction in the risk of subsequent life-threatening VTAs. (Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)
- cardiac resynchronization therapy
- heart failure
- implantable cardioverter-defibrillator
- reverse remodeling
- ventricular arrhythmia
This research was carried out while Dr. Barsheshet was a Mirowski-Moss Career Development Awardee at the University of Rochester Medical Center, Rochester, New York. The MADIT-CRT study was supported by a research grant from Boston Scientific, St. Paul, Minnesota, to the University of Rochester School of Medicine and Dentistry. Dr. Wang receives fellowship support and funding for clinical trials from Medtronic, Boston Scientific, and St. Jude Medical; and honoraria from Boston Scientific. Dr. Moss received a research grant from Boston Scientific. Dr. Al-Ahmad received honoraria from Boston Scientific, Medtronic, and St. Jude Medical. Dr. Foster received grant support from Boston Scientific, EBR Systems, Inc., Evalve, Abbott Vascular, Inc., and GDS Systems Inc. Dr. Huang is a speaker for and receives honoraria/research support from Boston Scientific. Dr. Klein received a research grant from Boston Scientific. Dr. Zareba received a research grant from Boston Scientific. Dr. Solomon is a consultant to Boston Scientific. All other authors have reported that they have no relationships to disclose.
- Received September 30, 2010.
- Revision received February 20, 2011.
- Accepted March 8, 2011.
- American College of Cardiology Foundation