Cardiac Resynchronization Therapy Reduces Left Atrial Volume and the Risk of Atrial Tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)

Abstract

In the MADIT-CRT study, favorable reverse remodeling of the left atrium with CRT-D therapy was associated with a significant reduction in risk of subsequent AT. (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271).

Percutaneous ventricular restoration (PVR) therapy using the Parachute device in 100 subjects with ischaemic dilated heart failure: one-year primary endpoint results of PARACHUTE III, a European trial

“…Another element supporting the fact that the Parachute affects diastolic compliance is the demonstration of remodelling of the left atrium, which is a surrogate measure for reducing left ventricle end-diastolic filling pressure. Cardiac resynchronisation therapy (CRT) is the only other medical device for HF subjects that has shown left atrial remodelling 21 . In comparison to other structural heart and HF devices, the vascular complications are less than those observed in transcatheter aortic valve replacement (TAVR) which uses a similar access method, while the haemodynamic and functional improvements are similar to those observed in CRT 10,21,22 .…”

“…Cardiac resynchronisation therapy (CRT) is the only other medical device for HF subjects that has shown left atrial remodelling 21 . In comparison to other structural heart and HF devices, the vascular complications are less than those observed in transcatheter aortic valve replacement (TAVR) which uses a similar access method, while the haemodynamic and functional improvements are similar to those observed in CRT 10,21,22 . The ongoing US pivotal trial, PARACHUTE IV, will enrol 560 subjects and will complement the level of evidence for this technology since it will be the first trial randomising against all appropriate medical therapy (AAMT) according to the current ACC/AHA guideline update for the diagnosis and management of chronic heart failure 23 .…”

Atrial fibrillation in cardiac resynchronization recipients with and without prior arrhythmic history. How much of arrhythmia is too much?

“…Several studies analyzed device-stored data to assess the incidence of AF in CRT patients [5,[8][9][10][11][12][13][14][15][16][17]. However, in the great majority of them + p < 0.05 vs. group with AF during follow-up; #79 patients survived the 24-month period: 10 with and 69 without AF history prior to cardiac resynchronization therapy.…”

“…To our knowledge, in only 2 studies device-collected arrhythmic data were gathered for over 2 years. In MADIT-CRT substudy, patients were monitored for the average of 2.9 years and AF incidence within this period ranged from 3% to 9% [8]. However, this trial included only patients with less advanced HF (NYHA class I/II).…”

Almanac 2013: cardiac arrhythmias and pacing

“…Following the landmark MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronisation Therapy) study, which demonstrated that CRT combined with implantable cardioverter defibrillator (ICD, CRT-D) decreased the risk of heart failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complexes (66), a number of subsequent analyses have provided further interesting information. This includes data on the benefits of CRT in reducing the risk of recurring heart failure events (67) and atrial arrhythmias (68), identification of additional factors that are associated with improved response to CRT (69,70) and with a super-response (defined by patients in the top quartile of LVEF change) (71), factors associated with greatest improvement in quality of life (72), and information on optimal lead positioning of the LV lead (73,74).…”