@article{174a470431a149d194594f52cfa1b782,
title = "Cardiac resynchronization therapy reduces left atrial volume and the risk of atrial tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)",
abstract = "Objectives: We hypothesized that reductions in left atrial volume (LAV) with a cardiac resynchronization therapydefibrillator (CRT-D) would translate into a subsequent reduction in the risk of atrial tachyarrhythmias (AT). Background: There is limited information regarding the effect of CRT-D on the risk of AT. Methods: Percent reduction in LAV at 1 year following CRT-D implantation (pre-specified as low [lowest quartile: <20% reduction in LAV] and high [<20% reduction in LAV] response to CRT-D) were related to the risk of subsequent AT (comprising atrial fibrillation, atrial flutter, atrial tachycardia, and supraventricular tachyarrhythmias) among patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy). Results: The cumulative probability of AT 2.5 years after assessment of echocardiographic response was lowest among high LAV responders to CRT-D (3%) and significantly higher among both low LAV responders to CRT-D (9%) and implantable cardioverter-defibrillatoronly patients (7%; p = 0.03 for the difference among the 3 groups). Consistently, multivariate analysis showed that high LAV responders to CRT-D experienced a significant 53% (p = 0.01) reduction in the risk of subsequent AT as compared with implantable cardioverter-defibrillatoronly patients, whereas low LAV responders did not derive a significant risk reduction with CRT-D therapy (hazard ratio [HR]: 1.05 [95% confidence interval (CI): 0.54 to 2.00]; p = 0.89). Patients who developed in-trial AT experienced significant increases in the risk for both the combined endpoint of heart failure or death (HR: 2.28 [95% CI: 1.45 to 3.59]; p < 0.001) and the separate occurrence of all-cause mortality (HR: 1.89 [95% CI: 1.08 to 3.62]; p = 0.01). Conclusions: In the MADIT-CRT study, favorable reverse remodeling of the left atrium with CRT-D therapy was associated with a significant reduction in risk of subsequent AT. (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)",
keywords = "atrial tachyarrhythmias, cardiac resynchronization therapy, heart failure",
author = "Andrew Brenyo and Link, {Mark S.} and Alon Barsheshet and Moss, {Arthur J.} and Wojciech Zareba and Wang, {Paul J.} and Scott McNitt and David Huang and Elyse Foster and Mark Estes and Solomon, {Scott D.} and Ilan Goldenberg",
note = "Funding Information: Dr. Barsheshet is a Mirowski-Moss Career Development Awardee in Cardiology. The MADIT-CRT study was supported by a research grant from Boston Scientific , St. Paul, Minnesota, to the University of Rochester School of Medicine and Dentistry. Funding Information: Drs. Zareba and Solomon have received research grant support from Boston Scientific . Dr. Foster has received grant support from Boston Scientific , EBR Systems, Inc. , Evalve , Abbott Vascular , and GDS Systems Inc . Dr. Estes has served as a consultant to Boston Scientific and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Brenyo, Link, and Goldenberg contributed equally to this work. ",
year = "2011",
month = oct,
day = "11",
doi = "10.1016/j.jacc.2011.07.020",
language = "אנגלית",
volume = "58",
pages = "1682--1689",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier Inc.",
number = "16",
}