Cardiac resynchronization therapy reduces left atrial volume and the risk of atrial tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)

Andrew Brenyo, Mark S. Link, Alon Barsheshet, Arthur J. Moss, Wojciech Zareba, Paul J. Wang, Scott McNitt, David Huang, Elyse Foster, Mark Estes, Scott D. Solomon, Ilan Goldenberg

Research output: Contribution to journalArticle

73 Scopus citations

Abstract

Objectives: We hypothesized that reductions in left atrial volume (LAV) with a cardiac resynchronization therapydefibrillator (CRT-D) would translate into a subsequent reduction in the risk of atrial tachyarrhythmias (AT). Background: There is limited information regarding the effect of CRT-D on the risk of AT. Methods: Percent reduction in LAV at 1 year following CRT-D implantation (pre-specified as low [lowest quartile: <20% reduction in LAV] and high [<20% reduction in LAV] response to CRT-D) were related to the risk of subsequent AT (comprising atrial fibrillation, atrial flutter, atrial tachycardia, and supraventricular tachyarrhythmias) among patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy). Results: The cumulative probability of AT 2.5 years after assessment of echocardiographic response was lowest among high LAV responders to CRT-D (3%) and significantly higher among both low LAV responders to CRT-D (9%) and implantable cardioverter-defibrillatoronly patients (7%; p = 0.03 for the difference among the 3 groups). Consistently, multivariate analysis showed that high LAV responders to CRT-D experienced a significant 53% (p = 0.01) reduction in the risk of subsequent AT as compared with implantable cardioverter-defibrillatoronly patients, whereas low LAV responders did not derive a significant risk reduction with CRT-D therapy (hazard ratio [HR]: 1.05 [95% confidence interval (CI): 0.54 to 2.00]; p = 0.89). Patients who developed in-trial AT experienced significant increases in the risk for both the combined endpoint of heart failure or death (HR: 2.28 [95% CI: 1.45 to 3.59]; p < 0.001) and the separate occurrence of all-cause mortality (HR: 1.89 [95% CI: 1.08 to 3.62]; p = 0.01). Conclusions: In the MADIT-CRT study, favorable reverse remodeling of the left atrium with CRT-D therapy was associated with a significant reduction in risk of subsequent AT. (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)

Original languageEnglish (US)
Pages (from-to)1682-1689
Number of pages8
JournalJournal of the American College of Cardiology
Volume58
Issue number16
DOIs
StatePublished - Oct 11 2011

    Fingerprint

Keywords

  • atrial tachyarrhythmias
  • cardiac resynchronization therapy
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this