Background
Cardiac resynchronization therapy (CRT) is increasingly recognized for its ability
to reduce ventricular tachyarrhythmias, possibly associated with left ventricular
reverse remodeling, but the role of the right ventricle (RV) in this process has not
been examined.
Objective
The purpose of this study was to investigate the relationship between ventricular
tachyarrhythmias and change in RV dimensions in patients receiving CRT with a defibrillator
(CRT-D).
Methods
Multivariate Cox proportional hazards regression modeling was used to assess the risk
for fast (≥180 bpm) ventricular tachycardia/ventricular fibrillation (VT/VF) or death
by baseline and follow-up RV size (defined as right ventricular end-diastolic area
[RVEDA]) among 1495 patients enrolled in the Multicenter Automatic Defibrillator Implantation
Trial with Cardiac Resynchronization Therapy (MADIT-CRT).
Results
Multivariate analysis showed that treatment with CRT-D was independently associated
with a 27% (P = .003) reduction in the risk of VT/VF or death among patients with larger RVs (>first
quartile RVEDA ≥13 mm2/m2) compared with implantable cardioverter-defibrillator (ICD)-only therapy, whereas
in patients with smaller RVs there was no significant difference in the risk of VT/VF
between the 2 treatment arms (hazard ratio = 1.00, P = .99). At 1-year follow-up, CRT-D patients displayed significantly greater reductions
in RVEDA compared to ICD-only patients (P <.001), associated with a corresponding reduction in the risk of subsequent VT/VF
or death (>first quartile reduction in RVEDA with CRT-D vs ICD-only: hazard ratio
= 0.55, P <.001) independent of changes in left ventricular dimensions.
Conclusion
Our findings suggest that the RV may have an important role in determining the antiarrhythmic
effect of CRT independent of the effect of the device on the left ventricle.
Abbreviations:
BSA (body surface area), CI (confidence interval), CRT (cardiac resynchronization therapy), CRT-D (cardiac resynchronization therapy defibrillator), HR (hazard ratio), ICD (implantable cardioverter-defibrillator), LV (left ventricle), MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy), NYHA (New York Heart Association), RV (right ventricle), RVEDA (right ventricular end-diastolic area), RVFAC (right ventricular fractional area change), VF (ventricular fibrillation), VT (ventricular tachycardia)Keywords
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Article info
Publication history
Published online: July 22, 2013
Footnotes
The first two authors contributed equally to this paper. Drs. Moss, Solomon, Hall, and Zareba have received research support for the conduct of the MADIT-CRT trial from Boston Scientific through a grant to the University of Rochester. Dr. Goldenberg receives research support from Boston Scientific and the Mirowski Foundation.
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© 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
