Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York.
Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York.
Heart Rhythm. 2021 May;18(5):762-769. doi: 10.1016/j.hrthm.2020.12.034. Epub 2021 Jan 11.
Cardiac resynchronization therapy-defibrillator (CRT-D) may reduce the incidence of first ventricular tachyarrhythmia (VTA) in patients with heart failure (HF) and left bundle branch block (LBBB).
The purpose of this study was to assess the effect of CRT-D on VTA burden in LBBB patients.
We included 1281 patients with LBBB from MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). VTA was defined as any treated or monitored sustained ventricular tachycardia (VT ≥180 bpm) or ventricular fibrillation (VF). Life-threatening VTA was defined as VT ≥200 bpm or VF. VTA recurrence was assessed using the Andersen-Gill model.
During a mean follow-up of 2.5 years, 964 VTA episodes occurred in 264 patients (21%). The VTA rate per 100 person-years was significantly lower in the CRT-D group compared with the implantable cardioverter-defibrillator (ICD) group (20 vs 34; P <.01). Multivariate analysis demonstrated that CRT-D treatment was associated with a 32% risk reduction for VTA recurrence (hazard ratio 0.68; 95% confidence interval 0.57-0.82; P <.001), 57% risk reduction for recurrent life-threatening VTA, 54% risk reduction for recurrent appropriate ICD shocks, and 25% risk reduction for the combined endpoint of VTA and death. The effect of CRT-D on VTA burden was consistent among all tested subgroups but was more pronounced among patients in New York Heart Association functional class I. Landmark analysis showed that at 2 years, the cumulative probability of death subsequent to year one was highest (16%) among patients who had ≥2 VTA events during their first year.
In patients with LBBB and HF, early intervention with CRT-D reduces mortality, VTA burden, and frequency of multiple appropriate ICD shocks. VTA burden is a powerful predictor of subsequent mortality.
心脏再同步治疗除颤器（CRT-D）可降低心力衰竭（HF）伴左束支传导阻滞（LBBB）患者首次室性心动过速（VTA）的发生率。
本研究旨在评估 CRT-D 对 LBBB 患者 VTA 负荷的影响。
我们纳入了 MADIT-CRT（多中心自动除颤器植入试验-心脏再同步治疗）中的 1281 例 LBBB 患者。VTA 定义为任何治疗或监测到的持续性室性心动过速（VT≥180bpm）或心室颤动（VF）。危及生命的 VTA 定义为 VT≥200bpm 或 VF。使用 Andersen-Gill 模型评估 VTA 复发情况。
在平均 2.5 年的随访期间，264 例患者（21%）发生了 964 次 VTA 发作。与植入式心脏复律除颤器（ICD）组相比，CRT-D 组的 VTA 发生率/100 人年显著降低（20 次 vs 34 次；P<.01）。多变量分析表明，CRT-D 治疗与 VTA 复发风险降低 32%相关（风险比 0.68；95%置信区间 0.57-0.82；P<.001），与复发危及生命的 VTA 风险降低 57%、复发适当 ICD 电击风险降低 54%以及 VTA 和死亡的联合终点风险降低 25%相关。CRT-D 对 VTA 负荷的影响在所有测试亚组中均一致，但在纽约心脏协会功能分级 I 级的患者中更为明显。 landmark 分析显示，在第 1 年发生≥2 次 VTA 事件的患者中，第 1 年后的第 2 年死亡的累积概率最高（16%）。
在 LBBB 和 HF 患者中，早期采用 CRT-D 干预可降低死亡率、VTA 负荷和多次适当 ICD 电击的频率。VTA 负荷是随后死亡率的有力预测指标。
