Document Detail


Time dependence of life-threatening ventricular tachyarrhythmias after coronary revascularization in MADIT-CRT.
MedLine Citation:
PMID:  20620231     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Coronary revascularization (CR) may confer electrical stability in patients with ischemic cardiomyopathy. However, data regarding the effect of CR on the development of ventricular tachyarrhythmias in this population are limited.
OBJECTIVE: The purpose of this study was to evaluate the association between CR and arrhythmic risk in postmyocardial infarction (post-MI) patients with left ventricular dysfunction.
METHODS: The risk for life-threatening ventricular tachyarrhythmias (defined as a first appropriate defibrillator therapy for ventricular tachycardia [VT]/ventricular fibrillation [VF] or death) was compared between post-MI patients with and those without prior CR (n = 612 and 147, respectively) enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT).
RESULTS: The 3-year cumulative rate of VT/VF or death was significantly higher among patients without prior CR (42%) than in patients who underwent prior CR (32%, P = .02). Multivariate analysis demonstrated that patients without prior CR had 48% increased risk (P = .01) for VT/VF or death. Risk reduction associated with CR was related to elapsed time from CR, assessed both as a categorical variable (tertiles for time from CR: ≥7 years, hazard ratio [HR] = 1.93, P = .001; 1.5-7 years, HR = 1.70, P = .01 vs <1.5 years) and as a continuous measure (4%, P = .002, increased risk for VT/VF or death per 1-year increment of elapsed time from CR). The effect of CR on arrhythmic risk was similar in patients treated with a defibrillator alone or when combined with cardiac resynchronization therapy.
CONCLUSION: Post-MI patients with left ventricular dysfunction who undergo CR experience a time-dependent reduction in the risk for subsequent life-threatening ventricular tachyarrhythmias.
Authors:
Alon Barsheshet; Ilan Goldenberg; Craig R Narins; Arthur J Moss; Scott McNitt; Paul J Wang; David T Huang; W Jackson Hall; Wojciech Zareba; Michael Eldar; Victor Guetta
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-07-08
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1421-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiology Division, University of Rochester Medical Center, Rochester, New York 14642, USA. alon.barsheshet@heart.rochester.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00180271
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