PR interval identifies clinical response in patients with non-left bundle branch block : a multicenter automatic defibrillator implantation Trial-cardiac resynchronization therapy substudy

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Item Type:	Article
Title:	PR interval identifies clinical response in patients with non-left bundle branch block : a multicenter automatic defibrillator implantation Trial-cardiac resynchronization therapy substudy
Creators Name:	Kutyifa, V., Stockburger, M., Daubert, J.P., Holmqvist, F., Olshansky, B., Schuger, C., Klein, H., Goldenberg, I., Brenyo, A., McNitt, S., Merkely, B., Zareba, W. and Moss, A.J.
Abstract:	BACKGROUND: In MADIT-CRT, patients with non-LBBB (including RBBB, IVCD) did not have clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D). We hypothesized that baseline PR-interval modulates clinical response to CRT-D therapy in patients with non-LBBB. METHODS AND RESULTS: Non-LBBB patients (n=537, 30%) were divided in two groups based on their baseline PR-interval as normal (including minimally prolonged) PR (PR < 230 ms), and prolonged PR (PR >/= 230 ms). The primary end point was heart failure (HF) or death. Separate secondary end points included HF events and all-cause mortality. Cox proportional hazards regression models were used to compare risk of end point events by CRT-D to ICD therapy in the PR subgroups. There were 96 patients (22%) with a prolonged PR and 438 patients (78%) with a normal PR interval. In non-LBBB patients with a prolonged PR-interval, CRT-D treatment was associated with a 73% reduction in the risk of HF/Death (HR=0.27, 95% CI: 0.13-0.57, p<0.001) and 81% decrease in the risk of all-cause mortality (HR=0.19, 95% CI: 0.13-0.57, p<0.001) compared to ICD therapy. In non-LBBB patients with normal PR, CRT-D therapy was associated with a trend towards an increased risk of HF/Death (HR=1.45, 95% CI: 0.96-2.19, p=0.078, interaction p-value<0.001) and more than a 2-fold higher mortality (HR=2.14, 95% CI: 1.12-4.09, p=0.022, interaction p-value<0.001) compared to ICD therapy. CONCLUSIONS: The data support the use of CRT-D in MADIT-CRT, non-LBBB patients with a prolonged PR-interval. In non-LBBB patients with a normal PR-interval, implantation of a CRT-D may be deleterious. Clinical Trial Registration: http://clinicaltrials.gov; Unique Identifier: NCT00180271.
Keywords:	Atrioventricular Block, Cardiac Resynchronization Therapy, Defibrillators, Implantable, Heart Failure, Mortality,
Source:	Circulation Arrhythmia and Electrophysiology
ISSN:	1941-3149
Publisher:	American Heart Association
Volume:	7
Number:	4
Page Range:	645-651
Date:	August 2014
Additional Information:	Authors' reply in: Circ Arrhythm Electrophyiol 7(6): 1280.
Official Publication:	https://doi.org/10.1161/CIRCEP.113.001299
PubMed:	View item in PubMed

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