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Left Ventricular Pacing Threshold and Outcome in Madit-CRT.
MedLine Citation:
PMID:  24786979     Owner:  NLM     Status:  Publisher    
INTRODUCTION: High left ventricular (LV) pacing threshold (PT) may in some cases indicate the presence of scarred myocardium, a predictor of poor outcome in CRT treated patients. We hypothesized that intraoperative LVPT can be used to determine echocardiographic and clinical responses to CRT.
METHODS AND RESULTS: The study comprised 975 patients enrolled in the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT). Multivariate regression analysis was performed to evaluate the relationship between LVPT and percent reduction in LV end-systolic volume (ESV) and left atrial volume (LAV) 1 year after CRT, and to identify factors associated with continuous and high (upper quartile, >1.8 V) LVPT. Cox proportional hazards analysis was used to evaluate the relationship between LVPT and heart failure (HF) events or death (primary endpoint) and all cause death (secondary endpoint). An increasing LVPT was inversely related to percent reduction in both LVESV (p = 0.02) and LAV (p<0.01). Patients with LVPT in the highest quartile (>1.8 V) were less likely to achieve reverse LV remodeling (≥15% LVESV reduction from baseline) than those with LVPT in the lower quartiles (hazard ratios [HR] OR 0.56, p = 0.02). Mean percent reduction in LAV and LVESV was also significantly greater among those with lowest quartile LVPT. Multivariate analysis showed borderline significant 13% (p = 0.06) and significant 22% (p = 0.03) increase in the risk of HF/death and death alone, respectively, per 1 volt increase in LVPT.
CONCLUSION: High intraoperative LVPT is associated with significantly lower echocardiographic and clinical response to CRT-D. This article is protected by copyright. All rights reserved.
Luis A Pires; Scott McNitt; Scott Solomon; Ilan Goldenberg; Wojciech Zareba; Arthur J Moss
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-30
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-5-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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