Cardiac resynchronization therapy and ventricular tachyarrhythmia burden

Sinan Tankut, Ilan Goldenberg, Valentina Kutyifa, Wojciech Zareba, Nicola Luigi Bragazzi, Scott McNitt, David T. Huang, Mehmet K. Aktas, Arwa Younis

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)762-769
Number of pages8
JournalHeart Rhythm
Volume18
Issue number5
DOIs
StatePublished - May 2021
Externally publishedYes

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Left bundle branch block
  • Ventricular fibrillation
  • Ventricular tachycardia arrhythmia

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