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The association between biventricular pacing and cardiac resynchronization therapy-defibrillator efficacy when compared with implantable cardioverter defibrillator on outcomes and reverse remodelling.

Publication ,  Journal Article
Ruwald, A-C; Kutyifa, V; Ruwald, MH; Solomon, S; Daubert, JP; Jons, C; Brenyo, A; McNitt, S; Do, D; Tanabe, K; Al-Ahmad, A; Wang, P; Moss, AJ ...
Published in: Eur Heart J
February 14, 2015

AIMS: Previous studies on biventricular (BIV) pacing and cardiac resynchronization therapy-defibrillator (CRT-D) efficacy have used arbitrarily chosen BIV pacing percentages, and no study has employed implantable cardioverter defibrillator (ICD) patients as a control group. METHODS AND RESULTS: Using Kaplan-Meier plots, we estimated the threshold of BIV pacing percentage needed for CRT-D to be superior to ICD on the end-point of heart failure (HF) or death in 1219 left bundle branch block (LBBB) patients in the MADIT-CRT trial. Patients were censored at the time of crossover. In multivariable Cox analyses, no difference was seen in the risk of HF/death between ICD and CRT-D patients with BIV pacing ≤90% [HR = 0.78 (0.47-1.30), P = 0.344], and with increasing BIV pacing the risk of HF/death was decreased [CRT-D BIV 91-96% vs. ICD: HR = 0.63 (0.42-0.94), P = 0.024 and CRT-D BIV ≥97% vs. ICD: HR = 0.32 (0.23-0.44), P < 0.001]. The risk of death alone was reduced by 52% in CRT-D patients with BIV ≥97% (HR = 0.48, P < 0.016), when compared with ICD patients. Within the CRT-D group, for every 1 percentage point increase in BIV pacing, the risk of HF/death and death alone significantly decreased by 6 and 10%, respectively. Increasing BIV pacing percentage was associated with significant reductions in left ventricular volume. CONCLUSION: In patients with LBBB, who were in sinus rhythm at enrolment, BIV pacing exceeding 90% was associated with a benefit of CRT-D in HF/death when compared with ICD patients. Furthermore, BIV pacing ≥97% was associated with an even further reduction in HF/death, a significant 52% reduction in death alone, and increased reverse remodelling. Clinical trials.gov identifier: NCT00180271.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

February 14, 2015

Volume

36

Issue

7

Start / End Page

440 / 448

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Treatment Outcome
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Failure
  • Female
  • Defibrillators, Implantable
  • Cardiovascular System & Hematology
 

Citation

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Ruwald, A.-C., Kutyifa, V., Ruwald, M. H., Solomon, S., Daubert, J. P., Jons, C., … Zareba, W. (2015). The association between biventricular pacing and cardiac resynchronization therapy-defibrillator efficacy when compared with implantable cardioverter defibrillator on outcomes and reverse remodelling. Eur Heart J, 36(7), 440–448. https://doi.org/10.1093/eurheartj/ehu294
Ruwald, Anne-Christine, Valentina Kutyifa, Martin H. Ruwald, Scott Solomon, James P. Daubert, Christian Jons, Andrew Brenyo, et al. “The association between biventricular pacing and cardiac resynchronization therapy-defibrillator efficacy when compared with implantable cardioverter defibrillator on outcomes and reverse remodelling.Eur Heart J 36, no. 7 (February 14, 2015): 440–48. https://doi.org/10.1093/eurheartj/ehu294.
Ruwald A-C, Kutyifa V, Ruwald MH, Solomon S, Daubert JP, Jons C, Brenyo A, McNitt S, Do D, Tanabe K, Al-Ahmad A, Wang P, Moss AJ, Zareba W. The association between biventricular pacing and cardiac resynchronization therapy-defibrillator efficacy when compared with implantable cardioverter defibrillator on outcomes and reverse remodelling. Eur Heart J. 2015 Feb 14;36(7):440–448.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

February 14, 2015

Volume

36

Issue

7

Start / End Page

440 / 448

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Treatment Outcome
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Failure
  • Female
  • Defibrillators, Implantable
  • Cardiovascular System & Hematology