Time-dependent risk reduction of ventricular tachyarrhythmias in cardiac resynchronization therapy patients: a MADIT-RIT sub-study

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Item Type:	Article
Title:	Time-dependent risk reduction of ventricular tachyarrhythmias in cardiac resynchronization therapy patients: a MADIT-RIT sub-study
Creators Name:	Stockburger, M., Moss, A.J., Olshansky, B., Klein, H., McNitt, S., Schuger, C., Daubert, J.P., Goldenberg, I., Ruwald, A.C.H., Merkely, B., Zareba, W. and Kutyifa, V.
Abstract:	Aims: Data on the time-dependent benefit of cardiac resynchronization therapy with defibrillator (CRT-D) compared with a dual-chamber implantable cardioverter-defibrillator (ICD) to reduce death or ventricular tachycardia (VT) or ventricular fibrillation (VF) are limited. We aimed to evaluate the time-related risk of death or sustained VT or VF in patients receiving CRT-D vs. ICD in the MADIT-RIT trial. Methods and results: Kaplan-Meier survival analyses and multivariate Cox regression models were utilized to compare the incidence and the risk of death or sustained VT/VF in the CRT-D and ICD subgroups by the elapsed time after device implantation (6 months). Of the ICD (n = 742) and CRT-D (n = 757) patients enrolled, the risk of death was lower in CRT-D vs. in ICD early after device implantation [hazard ratio (HR) = 0.42, 95% confidence interval (CI): 0.17-1.03, P = 0.058] and beyond 6 months of follow-up (HR = 0.39, 95% CI: 0.21-0.73, P = 0.004), with the 6-month interaction P = 0.899. The overall risk of sustained VT/VF was reduced in CRT-D vs. ICD patients (HR = 0.73, 95% CI: 0.52-1.03, P = 0.07). However, the risk was similar in the first 6 months (HR = 1.00, 95% CI: 0.62-1.62, P = 0.988), and a lower risk emerged 6 months after CRT-D implantation (HR = 0.58, 95% CI: 0.38-0.88, P = 0.011), with the 6-month interaction P = 0.059. Conlusion: The reduced mortality risk of CRT-D compared with an ICD alone began early after device implantation and was sustained during long-term follow-up; the reduced risk for ventricular tachyarrhythmias did not emerge until 6 months after device implantation. Clinical trial registration: http://clinicaltrials.gov/ct2/show/NCT00947310.
Keywords:	Cardiac Resynchronization Therapy, Implantable Cardioverter-Defibrillator, Ventricular Tachycardia, Ventricular Fibrillation, MADIT-RIT
Source:	Europace
ISSN:	1099-5129
Publisher:	Oxford University Press
Volume:	17
Number:	7
Page Range:	1085-1091
Date:	July 2015
Official Publication:	https://doi.org/10.1093/europace/euv008
PubMed:	View item in PubMed

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