Cardiac resynchronization therapy is associated with reductions in left atrial volume and inappropriate implantable cardioverter-defibrillator therapy in MADIT-CRT.

Autor:	Slyngstad T; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York., Huth Ruwald AC; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York; Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark., Kutyifa V; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York., McNitt S; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York., Polonsky B; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York., Solomon SD; Brigham and Women's Hospital, Boston, Massachusetts., Foster E; University of California San Francisco Hospital, San Francisco, California., Goldenberg I; Sheba Medical Center and Tel Aviv University, Tel Aviv, Israel., Wang PJ; Cardiology Division, Stanford University School of Medicine, Palo Alto, California., Klein H; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York., Zareba W; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York., Moss AJ; Heart Research Follow-up Program of the of the Department of Medicine, University of Rochester Medical Center, Rochester, New York. Electronic address: heartajm@heart.rochester.edu.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2014 Jun; Vol. 11 (6), pp. 1001-7. Date of Electronic Publication: 2014 Feb 04.
DOI:	10.1016/j.hrthm.2014.01.033
Abstrakt:	Background: There are no prior studies assessing the relationship between left atrial volume (LAV) and inappropriate implantable cardioverter-defibrillator (ICD) therapy following treatment with cardiac resynchronization therapy. Objective: The purpose of this study was to investigate the hypothesis that patients randomized to cardiac resynchronization therapy with defibrillator (CRT-D) in the Multicenter Automatic Defibrillator Trial-Cardiac Resynchronization Therapy (MADIT-CRT) who had significant LAV reductions would have reduced risks of inappropriate ICD therapy. Methods: Cardiac resynchronization remodeling was assessed by measuring LAV change between baseline and 12-month echocardiograms in 751 CRT-D treated patients. Patients were stratified into quartiles based on percent reduction of LAV change. High LAV responders were those in the highest 3 quartiles of LAV reduction (LAV reduction ≥21%). Low LAV responders were those in the lowest quartile of LAV reduction (LAV reduction <21%). Clinical factors associated with ≥21% reduction in LAV were evaluated by linear regression analysis. Results: In Cox proportional hazards regression analyses, high LAV responders had a 39% reduction in the risk of inappropriate therapy (hazard ratio 0.61, P = .04) and left bundle branch block patients exhibited an even greater risk reduction in inappropriate therapy (hazard ratio 0.51, P = .02) compared to low LAV responders during follow-up extending up to 3 years after the 12-month echocardiogram. High LAV responders also had a significantly lower risk of heart failure or death during follow-up than did low LAV responders. Conclusion: A ≥21% reduction in LAV with cardiac resynchronization therapy is associated with significant reductions in inappropriate ICD therapy and in heart failure or death during a 3-year follow-up. (Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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