Cardiac resynchronization therapy in patients with a prior history of atrial fibrillation: Insights from four major clinical trials.

Autor: Dalgaard F; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.; Department of Medicine, Nykøbing Falster Sygehus, Nykøbing, Denmark., Fudim M; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA., Al-Khatib SM; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Friedman DJ; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA., Abraham WT; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Cleland JGF; National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK., Curtis AB; Department of Medicine, University at Buffalo, Buffalo, New York, USA., Gold MR; Medical University of South Carolina, Charleston, South Carolina, USA., Kutyifa V; Division of Cardiology, Department of Medicine, University of Rochester Medical Center Rochester, Rochester, New York, USA., Linde C; Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden., Young J; Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA., Ali-Ahmed F; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Tang A; Department of Medicine, Western University, Ontario, Canada., Olivas-Martinez A; Department of Biostatistics, University of Washington, Seattle, Washington, USA., Inoue LYT; Department of Biostatistics, University of Washington, Seattle, Washington, USA., Sanders GD; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.; Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.; Evidence Synthesis Group, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2023 Sep; Vol. 34 (9), pp. 1914-1924. Date of Electronic Publication: 2023 Jul 31.
DOI: 10.1111/jce.16022
Abstrakt: Aims: To investigate the association of cardiac resynchronization therapy (CRT) on outcomes among participants with and without a history of atrial fibrillation (AF).
Methods: Individual-patient-data from four randomized trials investigating CRT-Defibrillators (COMPANION, MADIT-CRT, REVERSE) or CRT-Pacemakers (COMPANION, MIRACLE) were analyzed. Outcomes were time to a composite of heart failure hospitalization or all-cause mortality or to all-cause mortality alone. The association of CRT on outcomes for patients with and without a history of AF was assessed using a Bayesian-Weibull survival regression model adjusting for baseline characteristics.
Results: Of 3964 patients included, 586 (14.8%) had a history of AF; 2245 (66%) were randomized to CRT. Overall, CRT reduced the risk of the primary composite endpoint (hazard ratio [HR]: 0.69, 95% credible interval [CI]: 0.56-0.81). The effect was similar (posterior probability of no interaction = 0.26) in patients with (HR: 0.78, 95% CI: 0.55-1.10) and without a history of AF (HR: 0.67, 95% CI: 0.55-0.80). In these four trials, CRT did not reduce mortality overall (HR: 0.82, 95% CI: 0.66-1.01) without evidence of interaction (posterior probability of no interaction = 0.14) for patients with (HR: 1.09, 95% CI: 0.70-1.74) or without a history of AF (HR: 0.70, 95% CI: 0.60-0.97).
Conclusion: The association of CRT on the composite endpoint or mortality was not statistically different for patients with or without a history of AF, but this could reflect inadequate power. Our results call for trials to confirm the benefit of CRT recipients with a history of AF.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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