Martin Stockburger1,2, Arthur J Moss3, Helmut U Klein3, Wojciech Zareba3, Ilan Goldenberg3, Yitschak Biton3, Scott McNitt3, Valentina Kutyifa4. 1. Department Cardiology & Angiology, Charité University Hospital, Berlin, Germany. 2. Department of Cardiology, Havelland Kliniken, Nauen, Germany. 3. Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA. 4. Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA. Valentina.Kutyifa@heart.rochester.edu.
Abstract
OBJECTIVE: In MADIT-CRT, patients with non-LBBB (right bundle branch block or nonspecific ventricular conduction delay) and a prolonged PR-interval derived significant clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D) compared to an implantable cardioverter defibrillator (ICD)-only. We aimed to study the long-term outcome of non-LBBB patients by baseline PR-interval with CRT-D versus ICD-only. METHODS:Non-LBBB patients (n = 534) were dichotomized based on baseline PR-interval: normal PR (PR < 230 ms), and markedly prolonged PR (PR ≥ 230 ms). The primary end point was heart failure (HF) or death. Secondary end points were HF only and all-cause death. RESULTS: In patients with a prolonged PR-interval, CRT-D treatment related to a 67 % significant reduction in the risk of HF/death (HR = 0.33, 95 % CI 0.16-0.69, p = 0.003), 69 % decrease in HF (HR = 0.31, 95 % CI 0.14-0.68, p = 0.003), and 76 % reduction in the risk of death (HR = 0.24, 95 % CI 0.07-0.80, p = 0.020) compared to ICD-only (median follow-up 5.8 years). In normal PR-interval patients, CRT-D therapy was associated with a trend towards increased risk of HF/death (HR = 1.49, 95 % CI 0.98-2.25, p = 0.061), and significantly increased mortality (HR = 2.27, 95 % CI 1.16-4.44, p = 0.014). Significant statistical interaction with the PR-interval was demonstrated for all end points. Results were consistent for QRS 130-150 ms and QRS > 150 ms. CONCLUSION: In MADIT-CRT, non-LBBB patients with a prolonged PR-interval derive sustained long-term clinical benefit with reductions in heart failure or death from CRT-D implantation, compared to an ICD-only. Our findings support implantation of CRT-D in non-LBBB patients with prolonged PR-interval irrespective of baseline QRS duration.
RCT Entities:
OBJECTIVE: In MADIT-CRT, patients with non-LBBB (right bundle branch block or nonspecific ventricular conduction delay) and a prolonged PR-interval derived significant clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D) compared to an implantable cardioverter defibrillator (ICD)-only. We aimed to study the long-term outcome of non-LBBB patients by baseline PR-interval with CRT-D versus ICD-only. METHODS: Non-LBBB patients (n = 534) were dichotomized based on baseline PR-interval: normal PR (PR < 230 ms), and markedly prolonged PR (PR ≥ 230 ms). The primary end point was heart failure (HF) or death. Secondary end points were HF only and all-cause death. RESULTS: In patients with a prolonged PR-interval, CRT-D treatment related to a 67 % significant reduction in the risk of HF/death (HR = 0.33, 95 % CI 0.16-0.69, p = 0.003), 69 % decrease in HF (HR = 0.31, 95 % CI 0.14-0.68, p = 0.003), and 76 % reduction in the risk of death (HR = 0.24, 95 % CI 0.07-0.80, p = 0.020) compared to ICD-only (median follow-up 5.8 years). In normal PR-interval patients, CRT-D therapy was associated with a trend towards increased risk of HF/death (HR = 1.49, 95 % CI 0.98-2.25, p = 0.061), and significantly increased mortality (HR = 2.27, 95 % CI 1.16-4.44, p = 0.014). Significant statistical interaction with the PR-interval was demonstrated for all end points. Results were consistent for QRS 130-150 ms and QRS > 150 ms. CONCLUSION: In MADIT-CRT, non-LBBB patients with a prolonged PR-interval derive sustained long-term clinical benefit with reductions in heart failure or death from CRT-D implantation, compared to an ICD-only. Our findings support implantation of CRT-D in non-LBBB patients with prolonged PR-interval irrespective of baseline QRS duration.
Entities:
Keywords:
Cardiac resynchronization therapy; First-degree AV block; Left bundle branch block; MADIT-CRT; Non-left bundle branch block; PR-interval
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