Heart Failure -> Cardiac Resynchronization Therapy: -> Indications D-AB29 - LVADs, Barostim and Pacing Issues in HF management (ID 3) Abstract Plus

D-AB29-02 - Arrhythmic Burden And Heart Failure Functional Class In MADIT-CRT (ID 811)

 S. Tankut: Nothing relevant to disclose.


Background: There are limited data on the arrhythmic burden of mildly symptomatic ischemic heart failure (HF) patients who are eligible for cardiac resynchronization therapy (CRT).
Objective: To explore the effect of New York Heart Association (NYHA) functional class on recurrent sustained ventricular tachyarrhythmias (VTA), and to evaluate the effect of CRT on VTA burden by NYHA class among patients with left bundle branch block (LBBB).
Methods: Among 999 patients with ischemic HF enrolled in MADIT-CRT, the rate of recurrent VT by NYHA class was analyzed using a Prentice, Williams and Peterson model.
Results: At baseline, mean patient age was 67+9 years, and 265 (26%) patients had NYHA class I and 734 (74%) had NYHA class II symptoms. During mean follow up of 2.4 years, 221 unique VTA events occurred in 64 (24%) patients with NYHA class I, and 653 unique VTA events occurred in 191 (26%) patients with NYHA class II. The VTA event rate was similar in patients with NYHA class I vs class II symptoms (22.2 events per 100 patient-years vs 21.8 events per 100 patient-years respectively; p=0.56). Among those with NYHA class I and LBBB, treatment with CRT-D was associated with a pronounced 67% risk reduction for recurrent VTA when compared with ICD - only therapy (p=0.015). However, in patients with NYHA class II, the reduction with VTA burden associated with CRT-D was attenuated (HR=0.78; 95% CI 0.5-1.3; p=0.35) (Figure).
Conclusion: VTA burden is similar in patients with NYHA class I and II heart failure. Cardiac resynchronization therapy is associated with a pronounced reduction in VTA burden among patients with ischemic cardiomyopathy and NYHA class I symptoms.