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The Impact of Nonsustained Ventricular Tachycardia on Reverse Remodeling, Heart Failure, and Treated Ventricular Tachyarrhythmias in MADIT‐CRT
Author(s) -
MITTAL SUNEET,
AKTAS MEHMET K.,
MOSS ARTHUR J.,
MCNITT SCOTT,
KUTYIFA VALENTINA,
STEINBERG JONATHAN S.,
ZAREBA WOJCIECH
Publication year - 2014
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12456
Subject(s) - medicine , cardiology , ventricular tachycardia , implantable cardioverter defibrillator , heart failure , cardiac resynchronization therapy , ischemic cardiomyopathy , hazard ratio , ventricular fibrillation , tachycardia , cardiomyopathy , confidence interval , ejection fraction
PVCs/NSVT and Outcomes in MADIT‐CRT Introduction This study determined whether the presence of nonsustained ventricular tachycardia (NSVT) was predictive of clinical events in MADIT‐CRT (multicenter automatic defibrillator implantation trial‐cardiac resynchronization therapy) patients treated with CRT‐defibrillator. Methods and Results We analyzed 24‐hour Holters for the presence of NSVT. Patients were then stratified by the etiology (ischemic or nonischemic) of cardiomyopathy. The impact of NSVT on heart failure events (HF), implantable cardioverter‐defibrillator (ICD) therapy for rapid ventricular tachycardia (VT) or fibrillation (VF), and reverse remodeling was determined. At least a single episode of NSVT was recorded in 483 (49%) patients. These patients had a higher burden of premature ventricular contractions, lower percentage of biventricular (BiV) pacing, and significantly less reduction in left ventricular end‐diastolic and end‐systolic volumes. The risk of HF was significantly greater in patients with nonischemic cardiomyopathy and NSVT (hazard ratio [HR] 2.89; 95% confidence interval [CI]: 1.49–5.61; P = 0.002). The risk of rapid VT/VF was significantly greater (in both ischemic and nonischemic patients) when NSVT was observed (HR 2.06; 95% CI: 1.30–3.26; P = 0.002 in ischemic patients; HR 3.09; 95% CI: 1.80–5.28; P < 0.001 in nonischemic patients). Conclusions MADIT‐CRT patients with NSVT had a high burden of ventricular ectopy, lower percentage of BiV pacing, and less reverse remodeling. These patients had an increase in HF (in nonischemic cardiomyopathy patients) and rapid VT/VF ICD therapies (in ischemic and nonischemic patients). These findings may have implications for the management of nonsustained ventricular ectopy in CRT patients.