PMID- 31648742
OWN - NLM
STAT- MEDLINE
DCOM- 20201014
LR  - 20201014
IS  - 2405-5018 (Electronic)
IS  - 2405-500X (Linking)
VI  - 5
IP  - 10
DP  - 2019 Oct
TI  - Risk of Ventricular Tachyarrhythmic Events in Patients Who Improved 
      Beyond Guidelines for a Defibrillator in MADIT-CRT.
PG  - 1172-1181
LID - S2405-500X(19)30637-1 [pii]
LID - 10.1016/j.jacep.2019.08.009 [doi]
AB  - OBJECTIVES: This study assessed the arrhythmic risk of cardiac resynchronization 
      therapy (CRT) patients who improved beyond Heart Rhythm Society/European Society 
      of Cardiology guidelines for an implantable cardioverter-defibrillator (ICD) 
      (ischemic cardiomyopathy: left ventricular ejection fraction [LVEF] >35% or New 
      York Heart Association [NYHA] functional class I and if LVEF was 31% to 35%; 
      nonischemic cardiomyopathy: LVEF >35% or NYHA functional class I and if LVEF 
      was </=35%). BACKGROUND: It is currently unknown whether protection with a 
      defibrillator is still warranted in patients who respond to CRT. METHODS: This 
      study compared the risk of ICD therapy for any ventricular tachyarrhythmia (VTA) 
      and for fast VTA (>/=200 beats/min) among patients implanted with a CRT with a 
      defibrillator (CRT-D) in the MADIT-CRT (Multicenter Automatic Defibrillator 
      Implantation Trial with Cardiac Resynchronization Therapy) (N = 734) who improved 
      at 1 year beyond guideline recommendations for primary ICD therapy (group A) with 
      those who remained within guideline recommendations for an ICD at 1 year (group 
      B). RESULTS: Most patients implanted with a CRT-D device improved at 1 year 
      beyond guideline indications for an ICD (90%). Multivariate analysis showed lower 
      risks for any VTA and fast VTA among group A patients versus group 
      B patients (57% risk reduction; p = 0.0006 and 46% risk reduction; p = 0.068, 
      respectively). However, the 2-year rates of any VTA and fast VTA among CRT 
      patients who improved beyond guidelines indications for an ICD was still 
      substantial (VTA: 13% and 29%, and fast VTA: 7% and 16%, respectively). 
      CONCLUSIONS: Most patients with mild heart failure implanted with a CRT device 
      experience an improvement in left ventricular function and/or NYHA functional 
      class beyond guideline recommendations for primary ICD therapy. However, despite 
      this pronounced CRT response, there remains a substantial VTA risk, and 
      protection with a defibrillator may still be warranted in this population.
CI  - Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Sherazi, Saadia
AU  - Sherazi S
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York. Electronic address: saadia_sherazi@urmc.rochester.edu.
FAU - Shah, Fatima
AU  - Shah F
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York.
FAU - Kutyifa, Valentina
AU  - Kutyifa V
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York.
FAU - McNitt, Scott
AU  - McNitt S
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York.
FAU - Aktas, Mehmet K
AU  - Aktas MK
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York.
FAU - Polonsky, Bronislava
AU  - Polonsky B
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York.
FAU - Zareba, Wojciech
AU  - Zareba W
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York.
FAU - Goldenberg, Ilan
AU  - Goldenberg I
AD  - Department of Cardiology, University of Rochester Medical Center, Rochester, New 
      York.
LA  - eng
PT  - Journal Article
DEP - 20191002
PL  - United States
TA  - JACC Clin Electrophysiol
JT  - JACC. Clinical electrophysiology
JID - 101656995
SB  - IM
CIN - JACC Clin Electrophysiol. 2019 Oct;5(10):1182-1184. PMID: 31648743
EIN - JACC Clin Electrophysiol. 2019 Dec;5(12):1477. PMID: 31857050
MH  - Aged
MH  - *Cardiac Resynchronization Therapy
MH  - Cardiac Resynchronization Therapy Devices
MH  - Death, Sudden, Cardiac/*prevention & control
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Heart Failure/etiology/physiopathology/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/complications
MH  - Practice Guidelines as Topic
MH  - Recovery of Function
MH  - Risk
MH  - Stroke Volume
MH  - Tachycardia, Ventricular/*epidemiology
MH  - Ventricular Fibrillation/*epidemiology
OTO - NOTNLM
OT  - cardiac resynchronization
OT  - heart failure
OT  - ventricular arrhythmias
EDAT- 2019/10/28 06:00
MHDA- 2020/10/21 06:00
CRDT- 2019/10/26 06:00
PHST- 2019/05/22 00:00 [received]
PHST- 2019/07/29 00:00 [revised]
PHST- 2019/08/09 00:00 [accepted]
PHST- 2019/10/26 06:00 [entrez]
PHST- 2019/10/28 06:00 [pubmed]
PHST- 2020/10/21 06:00 [medline]
AID - S2405-500X(19)30637-1 [pii]
AID - 10.1016/j.jacep.2019.08.009 [doi]
PST - ppublish
SO  - JACC Clin Electrophysiol. 2019 Oct;5(10):1172-1181. doi: 
      10.1016/j.jacep.2019.08.009. Epub 2019 Oct 2.