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ARTICLE CONTRIBUTORS

Journal of the American College of Cardiology

News & Views

REVERSE REMODELLING REDUCES TACHYARRHYTHMIAS

Reverse remodelling is associated with a significant reduction in the risk of life-threatening ventricular tachyarrhythmias (VTAs) in patients with left ventricular dysfunction, according to a study1 of patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy).

Researchers led by Dr Alon Barsheshet (University of Rochester Medical Center, New York) evaluated the relationship between echocardiographic response to cardiac resynchronisation therapy (CRT) and the risk of ventricular tachyarrhythmias (VTA).  They compared the risk of high- and low-echocardiographic responders (n = 749), defined as ≥25% and <25% reductions, respectively, in left ventricular end-systolic volume [LVESV] at 1 year compared with baseline, and implantable cardioverter-defibrillator (ICD)-only patients (623) enrolled in the MADIT-CRT.

The risk of a first VTA at 2 years after echocardiographic assessment was highest among low responders to CRT-D (28%), intermediate among ICD-only patients (21%), and lowest among high responders to CRT-D (12%), with p < 0.001 for the overall difference during follow-up.  Multivariate analysis showed that high responders to CRT-D experienced a significant 55% reduction in the risk of VTA compared with ICD-only patients (p < 0.001), whereas the risk of VTA was not significantly different between low responders and ICD-only patients

(p < 0.21).

The study finds that responders to CRT-D therapy derive a significant reduction in the risk of life-threatening VTA, its authors suggesting that reverse remodelling had a dual effect of both heart failure (HF) and VTA risk reduction in the MADIT-CRT study population.  The importance of CRT-D therapy’s affect on responders is “underscored by the fact that ventricular arrhythmias and ICD shocks are associated with a reduction in quality of life and with a poor prognosis among patients with an indication for an ICD,” they say.  They also stress the importance of reverse remodelling as “a marker of both HF and VTA risk after CRT-D implantation”.

In her accompanying editorial,2 Dr Anne B. Curtis states that this study is valuable “in that it confirms and extends the results of previous studies to a population of patients with milder heart failure”.  She notes that, by design, the MADIT-CRT study did not include patients with more symptomatic heart failure, meaning that “it is not certain whether the results of this study would pertain to such patients”.

References

1 Barsheshet A, Wang PJ, Moss AJ, et al.  Reverse Remodeling and the Risk of Ventricular Tachyarrhythmias in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy).  JACC 2011;57:2416–23.

2 Curtis AB. Cardiac Resynchronization Therapy: Antiarrhythmic or Proarrhythmic? JACC 2011;57:2424–5.

Published on: August 2, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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