Reverse remodeling with CRT reduces life threatening ventricular arrhythmias

Reverse remodeling with CRT reduces life threatening ventricular arrhythmias

Reverse remodeling with CRT reduces life threatening ventricular arrhythmias: There have been some reports of whether the altered sequence of ventricular depolarization with cardiac resynchronization therapy (CRT) can be arrhythmogenic. Investigators of MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy) in a sub study analyzed whether this is true in their study patients [1]. They grouped the subjects into three – those with 25% or more reduction in left ventricular end systolic volume (LVESV) at one year compared with baseline, those with less than 25% reductions and those who received only ICD (implantable cardioverter defibrillator) and not CRT-D (CRT defibrillator). The first group was the CRT responders and the second one CRT non responders. The highest rates of ventricular tachyarrhythmias (including ventricular tachycardia, ventricular fibrillation, and ventricular flutter) was highest in the non responders (28%) and lowest in the responders (12%). The ICD only group had an intermediate value of 21%. This was for the cumulative probability of first ventricular tachyarrhythmia at two years after the initial assessment. Multivariate analysis showed a 55% risk reduction between CRT responders and ICD only patients, while the difference was not significant between non responders and ICD only patients. The authors conclude that reverse remodeling with CRT is associated with a significant risk reduction for life threatening ventricular arrhythmias.

Reference

1. Alon Barsheshet, Paul J Wang, Arthur J Moss, Scott D Solomon, Amin Al-Ahmad, Scott McNitt, Elyse Foster, David T Huang, Helmut U Klein, Wojciech Zareba, Michael Eldar, Ilan Goldenberg. Reverse remodeling and the risk of ventricular tachyarrhythmias in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). J Am Coll Cardiol. 2011 Jun 14;57(24):2416-23.