Cardiac resynchronization therapy and ventricular tachyarrhythmia burden.

Abstract

BACKGROUND:

Cardiac resynchronization therapy-defibrillator (CRT-D) may reduce the incidence of first ventricular tachyarrhythmia (VTA) in patients with heart failure (HF) and left bundle branch block (LBBB).

OBJECTIVE:

The purpose of this study was to assess the effect of CRT-D on VTA burden in LBBB patients.

METHODS:

We included 1281 patients with LBBB from MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). VTA was defined as any treated or monitored sustained ventricular tachycardia (VT ≥180 bpm) or ventricular fibrillation (VF). Life-threatening VTA was defined as VT ≥200 bpm or VF. VTA recurrence was assessed using the Andersen-Gill model.

RESULTS:

During a mean follow-up of 2.5 years, 964 VTA episodes occurred in 264 patients (21%). The VTA rate per 100 person-years was significantly lower in the CRT-D group compared with the implantable cardioverter-defibrillator (ICD) group (20 vs 34; P <.01). Multivariate analysis demonstrated that CRT-D treatment was associated with a 32% risk reduction for VTA recurrence (hazard ratio 0.68; 95% confidence interval 0.57-0.82; P <.001), 57% risk reduction for recurrent life-threatening VTA, 54% risk reduction for recurrent appropriate ICD shocks, and 25% risk reduction for the combined endpoint of VTA and death. The effect of CRT-D on VTA burden was consistent among all tested subgroups but was more pronounced among patients in New York Heart Association functional class I. Landmark analysis showed that at 2 years, the cumulative probability of death subsequent to year one was highest (16%) among patients who had ≥2 VTA events during their first year.

CONCLUSION:

In patients with LBBB and HF, early intervention with CRT-D reduces mortality, VTA burden, and frequency of multiple appropriate ICD shocks. VTA burden is a powerful predictor of subsequent mortality.

• Authors: Sinan Tankut, Ilan Goldenberg, Valentina Kutyifa, Wojciech Zareba, Nicola Luigi Bragazzi, Scott McNitt, David T Huang, Mehmet K Aktas, Arwa Younis
• Journal: Heart rhythm (Heart Rhythm) Vol. 18 Issue 5 Pg. 762-769 (05 2021) ISSN: 1556-3871 [Electronic] United States
• PMID: 33440249 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Canada (epidemiology)
• Cardiac Resynchronization Therapy (methods)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Survival Rate (trends)
• Tachycardia, Ventricular (epidemiology, therapy)
• Treatment Outcome
• United States (epidemiology)