Time dependence of life-threatening ventricular tachyarrhythmias after coronary revascularization in MADIT-CRT

Alon Barsheshet*, Ilan Goldenberg, Craig R. Narins, Arthur J. Moss, Scott McNitt, Paul J. Wang, David T. Huang, W. Jackson Hall, Wojciech Zareba, Michael Eldar, Victor Guetta

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1421-1427
Number of pages7
JournalHeart Rhythm
Volume7
Issue number10
DOIs
StatePublished - Oct 2010
Externally publishedYes

Funding

FundersFunder number
Boston Scientific, St. Jude
Medtronic
St. Jude Medical
Boston Scientific Corporation
School of Medicine and Dentistry, University of Rochester

    Keywords

    • Cardiac resynchronization therapy
    • Coronary revascularization
    • Heart failure
    • Myocardial infarction
    • Ventricular fibrillation
    • Ventricular tachycardia

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