JACC April 1, 2014
Volume 63, Issue 12
Arrhythmias and Clinical EP
cardiac rEsynchronization thErapy is associatEd with rEductions in LEft atriaL VoLumE
and inappropriatE icd thErapy in madit-crt
Room 146 C
Saturday, March 29, 2014, 9:15 a.m.-9:30 a.m.
Session Title: Cutting Edge Questions in Atrial Arrhythmias
Abstract Category: 8. Arrhythmias and Clinical EP: Devices
Presentation Number: 902-08
Authors: Tyler Slyngstad, Anne-Christine Ruwald, Valentina Kutyifa, Scott McNitt, Bronislava Polonsky, Scott Solomon, Elyse Foster, Ilan
Goldenberg, Paul Wang, Helmut Klein, Wojciech Zareba, Arthur Moss, University of Rochester, Rochester, NY, USA
background: We hypothesized that patients randomized to CRT-D in the MADIT-CRT trial who had significant left atrial volume (LAV) reductions
would have a reduced risk of inappropriate ICD therapy.
methods and results: LAV change between baseline and 12-month echocardiograms was assessed in 751 CRT-D treated patients. LAV
responders were stratified into quartiles based on percent reduction of LAV change: High LAV responders were those with the highest three quartiles
of LAV reduction (LAV reduction >21%) and low LAV responders were those with the lowest quartile of LAV reduction (LAV reduction <21%). Clinical
factors associated with >21% reduction in LAV with CRT therapy were evaluated by linear regression analysis and included LBBB, not having had
prior CABG surgery, a heart rate > 80bpm on the 12-lead ECG, a lower left ventricular end systolic volume index, and a higher left ventricular ejection
fraction. In Cox proportional-hazards regression analyses, the high LAV responders had a 39% reduction in the risk of inappropriate therapy (hazard
ratio 0.61, p=0.04) and LBBB patients exhibited an even greater risk reduction in inappropriate therapy (hazard ratio 0.51, p=0.02). The high LAV
responders also had a significantly lower risk of heart failure or death during long-term follow-up.
conclusions: A 21% or greater reduction in LAV with cardiac resynchronization therapy is associated with significant reductions in inappropriate
ICD therapy and in heart failure or death during a 3-year follow-up.