TY - JOUR
T1 - Time dependence of life-threatening ventricular tachyarrhythmias after coronary revascularization in MADIT-CRT
AU - Barsheshet, Alon
AU - Goldenberg, Ilan
AU - Narins, Craig R.
AU - Moss, Arthur J.
AU - McNitt, Scott
AU - Wang, Paul J.
AU - Huang, David T.
AU - Hall, W. Jackson
AU - Zareba, Wojciech
AU - Eldar, Michael
AU - Guetta, Victor
N1 - Funding Information:
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. Clinical Trial Registration Information: http://www.clinicaltrials.gov/ct2/show/NCT00180271 . Unique Identifier: NCT00180271 . Dr. Moss reports receiving grant support from Boston Scientific and lecture fees from Boston Scientific, Medtronic, and St. Jude Medical. Dr. Wang reports receiving a research grant from Boston Scientific , and Medtronic , lecture fees from Boston Scientific, St. Jude, and Lifewatch, and ownership interest of Hansen Medical, Vytronus, and Linea Medical. Dr. Huang reports receiving lecture fees from Boston Scientific and consultant fees from St. Jude. Dr. Zareba reports receiving research grant and lecture fees from Boston Scientific , and grant support from Medtronic . This research was performed while Dr. Alon Barsheshet was a Mirowski-Moss Career Development Awardee at the University of Rochester Medical Center, Rochester, New York.
PY - 2010/10
Y1 - 2010/10
N2 - Background: Coronary revascularization (CR) may confer electrical stability in patients with ischemic cardiomyopathy. However, data regarding the effect of CR on the development of ventricular tachyarrhythmias in this population are limited. Objective: The purpose of this study was to evaluate the association between CR and arrhythmic risk in postmyocardial infarction (post-MI) patients with left ventricular dysfunction. Methods: The risk for life-threatening ventricular tachyarrhythmias (defined as a first appropriate defibrillator therapy for ventricular tachycardia [VT]/ventricular fibrillation [VF] or death) was compared between post-MI patients with and those without prior CR (n = 612 and 147, respectively) enrolled in the Multicenter Automatic Defibrillator Implantation TrialCardiac Resynchronization Therapy (MADIT-CRT). Results: The 3-year cumulative rate of VT/VF or death was significantly higher among patients without prior CR (42%) than in patients who underwent prior CR (32%, P = .02). Multivariate analysis demonstrated that patients without prior CR had 48% increased risk (P = .01) for VT/VF or death. Risk reduction associated with CR was related to elapsed time from CR, assessed both as a categorical variable (tertiles for time from CR: <7 years, hazard ratio [HR] = 1.93, P = .001; 1.57 years, HR = 1.70, P = .01 vs <1.5 years) and as a continuous: measure (4%, P = .002, increased risk for VT/VF or death per 1-year increment of elapsed time from CR). The effect of CR on arrhythmic risk was similar in patients treated with a defibrillator alone or when combined with cardiac resynchronization therapy. Conclusion Post-MI patients with left ventricular dysfunction who undergo CR experience a time-dependent reduction in the risk for subsequent life-threatening ventricular tachyarrhythmias.
AB - Background: Coronary revascularization (CR) may confer electrical stability in patients with ischemic cardiomyopathy. However, data regarding the effect of CR on the development of ventricular tachyarrhythmias in this population are limited. Objective: The purpose of this study was to evaluate the association between CR and arrhythmic risk in postmyocardial infarction (post-MI) patients with left ventricular dysfunction. Methods: The risk for life-threatening ventricular tachyarrhythmias (defined as a first appropriate defibrillator therapy for ventricular tachycardia [VT]/ventricular fibrillation [VF] or death) was compared between post-MI patients with and those without prior CR (n = 612 and 147, respectively) enrolled in the Multicenter Automatic Defibrillator Implantation TrialCardiac Resynchronization Therapy (MADIT-CRT). Results: The 3-year cumulative rate of VT/VF or death was significantly higher among patients without prior CR (42%) than in patients who underwent prior CR (32%, P = .02). Multivariate analysis demonstrated that patients without prior CR had 48% increased risk (P = .01) for VT/VF or death. Risk reduction associated with CR was related to elapsed time from CR, assessed both as a categorical variable (tertiles for time from CR: <7 years, hazard ratio [HR] = 1.93, P = .001; 1.57 years, HR = 1.70, P = .01 vs <1.5 years) and as a continuous: measure (4%, P = .002, increased risk for VT/VF or death per 1-year increment of elapsed time from CR). The effect of CR on arrhythmic risk was similar in patients treated with a defibrillator alone or when combined with cardiac resynchronization therapy. Conclusion Post-MI patients with left ventricular dysfunction who undergo CR experience a time-dependent reduction in the risk for subsequent life-threatening ventricular tachyarrhythmias.
KW - Cardiac resynchronization therapy
KW - Coronary revascularization
KW - Heart failure
KW - Myocardial infarction
KW - Ventricular fibrillation
KW - Ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=77957276723&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2010.07.005
DO - 10.1016/j.hrthm.2010.07.005
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AN - SCOPUS:77957276723
SN - 1547-5271
VL - 7
SP - 1421
EP - 1427
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -
