Author + information
- Received August 18, 2013
- Revision received October 8, 2013
- Accepted October 28, 2013
- Published online April 1, 2014.
- Anne-Christine Ruwald, MD∗,†∗ ( )(, )
- Grzegorz Pietrasik, MD‡,
- Ilan Goldenberg, MD∗,§,
- Valentina Kutyifa, MD∗,‖,
- James P. Daubert, MD¶,
- Martin H. Ruwald, MD∗,†,
- Christian Jons, MD, PhD†,
- Scott McNitt, MS∗,
- Paul Wang, MD#,
- Wojciech Zareba, MD, PhD∗ and
- Arthur J. Moss, MD∗
- ∗University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, New York
- †Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
- ‡Division of Cardiology, University of Buffalo, Buffalo, New York
- §Heart Institute, Sheba Medical Center, Tel Hashomer, Israel
- ‖Semmelweis University Heart Center, Budapest, Hungary
- ¶Cardiology Division, Duke University Medical Center, Durham, North Carolina
- #Division of Cardiovascular Medicine, Stanford University, Stanford, California
- ↵∗Reprint requests and correspondence:
Dr. Anne-Christine H. Ruwald, Heart Research Follow-up Program, University of Rochester Medical Center, 265 Crittenden Boulevard, CU 420653, Rochester, New York 14642.
Objectives This study aimed to investigate the effect of both history of intermittent atrial tachyarrhythmias (IAT) and in-trial IAT on the risk of heart failure (HF) or death comparing cardiac resynchronization therapy with defibrillator (CRT-D) to implantable cardioverter-defibrillator (ICD) treatment in mildly symptomatic HF patients with left bundle branch block (LBBB).
Background Limited data exist regarding the benefit of CRT-D in patients with IAT.
Methods The benefit of CRT-D in reducing the risk of HF/death was evaluated using multivariate Cox models incorporating the presence of, respectively, a history of IAT at baseline and time-dependent development of in-trial IAT during follow-up in 1,264 patients with LBBB enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study.
Results The overall beneficial effect of CRT-D versus ICD on the risk of HF/death was not significantly different between LBBB patients with or without history of IAT (HR: 0.50, p = 0.028, and HR: 0.46, p < 0.001, respectively; p for interaction = 0.79). Among patients who had in-trial IAT, CRT-D was associated with a significant 57% reduction in the risk of HF/death compared with ICD-only therapy (HR: 0.43, p = 0.047), similar to the effect of the device among patients who did not have IAT (HR: 0.47, p < 0.001; p for interaction = 0.85). The percentage of patients with biventricular pacing ≥92% was similar in both groups (p = 0.43). Consistent results were shown for the benefit of CRT-D among patients who had in-trial atrial fibrillation/flutter (HR: 0.30, p = 0.027; p for interaction = 0.41).
Conclusions In the MADIT-CRT study, the clinical benefit of CRT-D in LBBB patients was not attenuated by prior history of IAT or by the development of in-trial atrial tachyarrhythmias. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy; NCT00180271)
- atrial arrhythmia
- cardiac resynchronization therapy
- heart failure
- implantable cardioverter-defibrillator
- left atrial volume
- left bundle branch block
- reverse remodeling
The MADIT-CRT study was supported by a research grant from Boston Scientific to the University of Rochester, with funds distributed to the coordination and data center, enrolling centers, core laboratories, committees, and boards under subcontracts from the University of Rochester. This research was performed while Dr. Anne-Christine Ruwald was a Mirowski-Moss Awardee. Dr. Ruwald has received travel grants from Falck Denmark and the Lundbeck-Foundation. Dr. Daubert has received grant support and lecture fees from Boston Scientific, Medtronic, and St. Jude Medical. Dr. Wang has received grant support and honoraria from Boston Scientific. Drs. Zareba and Moss have received grant support from Boston Scientific. Dr. Goldenberg has received grant support from Boston Scientific, Medtronic, and the Mirowski Foundation. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.
- Received August 18, 2013.
- Revision received October 8, 2013.
- Accepted October 28, 2013.
- 2014 American College of Cardiology Foundation