The impact of cardiac resynchronization therapy on ventricular tachycardia/fibrillation: an analysis from the combined Contak-CD and InSync-ICD studies.

OBJECTIVES

To determine the potential influence of cardiac resynchronization therapy (CRT) on the frequency and types of ventricular arrhythmia (VA) in patients with an indication for the implantable cardioverter-defibrillator (ICD), we performed a retrospective electrogram (EGM) analysis of stored VA events from the two largest CRT-ICD trials.

BACKGROUND

Previous reports suggest that CRT might promote polymorphic VT (PVT), while a beneficial effect of CRT on ventricular function might reduce the frequency of monomorphic VT (MVT). Theoretically, a balanced effect produces no change in overall VA.

METHODS

We analyzed stored EGMs from patients in the Contak-CD and Insync-ICD studies receiving appropriate therapy for VA. EGM inspection distinguishes MVT and PVT using morphologic criteria rather than cycle length classification alone.

RESULTS

Of 1,041 subjects entering the two trials, 880 were randomized CRT (N = 439) or control (N = 441). We were able to analyze 840 EGMs in 150 patients with VA, including 678 MVT episodes and 162 PVT episodes. These events were distributed among 68 patients with active CRT (390 MVT vs 111 PVT) and 82 patients assigned to control (288 MVT compared to 51 PVT). The apparent increase in PVT episodes in the CRT group is not significant and can be explained by a disproportionate number of episodes in a few patients. We were unable to identify clinical variables predictive of PVT during CRT.

CONCLUSIONS

CRT is not associated with a measurable increase in the incidence of PVT, or in a reduction in MVT in the combined InSync-ICD and Contak-CD populations.