Atrioventricular delay programming and the benefit of cardiac resynchronization therapy in MADIT-CRT
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Atrioventricular delay programming and the benefit of cardiac resynchronization therapy in MADIT-CRT. / Brenyo, Andrew; Kutyifa, Valentina; Moss, Arthur J; Mathias, Andrew; Barsheshet, Alon; Pouleur, Anne-Catherine; Knappe, Dorit; McNitt, Scott; Polonsky, Bronislava; Huang, David T; Solomon, Scott D; Zareba, Wojciech; Goldenberg, Ilan.
In: HEART RHYTHM, Vol. 10, No. 8, 08.2013, p. 1136-1143.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Atrioventricular delay programming and the benefit of cardiac resynchronization therapy in MADIT-CRT
AU - Brenyo, Andrew
AU - Kutyifa, Valentina
AU - Moss, Arthur J
AU - Mathias, Andrew
AU - Barsheshet, Alon
AU - Pouleur, Anne-Catherine
AU - Knappe, Dorit
AU - McNitt, Scott
AU - Polonsky, Bronislava
AU - Huang, David T
AU - Solomon, Scott D
AU - Zareba, Wojciech
AU - Goldenberg, Ilan
N1 - Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
PY - 2013/8
Y1 - 2013/8
N2 - BACKGROUND: The optimal atrioventricular pacing delay (AVD) in cardiac resynchronization therapy (CRT) remains to be determined.OBJECTIVE: To determine whether programming CRT devices to short AVD (S-AVD) will improve clinical response secondary to greater reductions in dyssynchrony.METHODS: The study population comprised 1235 patients with left bundle branch block enrolled in Multicenter Automatic Defibrillator Implantation Trial in Cardiac Resynchronization Therapy (MADIT-CRT). We assessed the relationship between AVD and outcomes. Patients programmed to S-AVD (median value of <120 ms; n = 337) vs long AVD (L-AVD; ≥120 ms; n = 390) were assessed for the end points of heart failure (HF) or death, death alone, and echocardiographic response to the CRT at 1-year follow-up. Outcomes were also compared to the left bundle branch block implantable cardioverter-defibrillator-only group (n = 508).RESULTS: Multivariate analysis showed that patients programmed to S-AVD experienced a significant 33% (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.44-0.85; P = .037) reduction in the risk of HF or death and a 47% (HR 0.53; 95% CI 0.29-0.94; P = .031) reduction in death alone as compared with those programmed to L-AVD. Patients with CRT-programmed S-AVD and L-AVD experienced 63% (HR 0.37; 95% CI 0.26-0.53; P < .001) and 46% (HR 0.54; 95% CI 0.31-0.96; P < .001) reduction, respectively, in the risk of HF or death compared to patients with implantable cardioverter-defibrillator alone. At 1 year of follow-up, S-AVD vs L-AVD was associated with a greater reduction in left ventricular end-systolic volume (34.2% vs 30.8%; P = .002) along with a significantly greater improvement in dyssynchrony (22.3% vs 9.4%; P = .036).CONCLUSIONS: Our findings indicate that in MADIT-CRT programming, the CRT AVD <120 ms was associated with a greater clinical and echocardiographic response to CRT.
AB - BACKGROUND: The optimal atrioventricular pacing delay (AVD) in cardiac resynchronization therapy (CRT) remains to be determined.OBJECTIVE: To determine whether programming CRT devices to short AVD (S-AVD) will improve clinical response secondary to greater reductions in dyssynchrony.METHODS: The study population comprised 1235 patients with left bundle branch block enrolled in Multicenter Automatic Defibrillator Implantation Trial in Cardiac Resynchronization Therapy (MADIT-CRT). We assessed the relationship between AVD and outcomes. Patients programmed to S-AVD (median value of <120 ms; n = 337) vs long AVD (L-AVD; ≥120 ms; n = 390) were assessed for the end points of heart failure (HF) or death, death alone, and echocardiographic response to the CRT at 1-year follow-up. Outcomes were also compared to the left bundle branch block implantable cardioverter-defibrillator-only group (n = 508).RESULTS: Multivariate analysis showed that patients programmed to S-AVD experienced a significant 33% (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.44-0.85; P = .037) reduction in the risk of HF or death and a 47% (HR 0.53; 95% CI 0.29-0.94; P = .031) reduction in death alone as compared with those programmed to L-AVD. Patients with CRT-programmed S-AVD and L-AVD experienced 63% (HR 0.37; 95% CI 0.26-0.53; P < .001) and 46% (HR 0.54; 95% CI 0.31-0.96; P < .001) reduction, respectively, in the risk of HF or death compared to patients with implantable cardioverter-defibrillator alone. At 1 year of follow-up, S-AVD vs L-AVD was associated with a greater reduction in left ventricular end-systolic volume (34.2% vs 30.8%; P = .002) along with a significantly greater improvement in dyssynchrony (22.3% vs 9.4%; P = .036).CONCLUSIONS: Our findings indicate that in MADIT-CRT programming, the CRT AVD <120 ms was associated with a greater clinical and echocardiographic response to CRT.
KW - Aged
KW - Bundle-Branch Block/diagnostic imaging
KW - Canada
KW - Cardiac Resynchronization Therapy/adverse effects
KW - Echocardiography
KW - Europe
KW - Female
KW - Heart Failure/diagnostic imaging
KW - Humans
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Survival Analysis
KW - Treatment Outcome
KW - United States
U2 - 10.1016/j.hrthm.2013.04.013
DO - 10.1016/j.hrthm.2013.04.013
M3 - SCORING: Journal article
C2 - 23712031
VL - 10
SP - 1136
EP - 1143
JO - HEART RHYTHM
JF - HEART RHYTHM
SN - 1547-5271
IS - 8
ER -
