CRT-D Provides Greater Long-Term Benefit Than ICD Alone

Cardiac resynchronization therapy with a defibrillator (CRT-D), as compared to implantable cardiac defibrillation (ICD) alone, is associated with significant reductions in the long-term risk of heart failure or death, according to findings presented Sept. 3 at the ESC Congress 2013 in Amsterdam.

“The message here is that the class II [heart failure] patients getting CRT for a wide QRS are seeing a long term benefit,” said Alfred Bove, MD, MACC.
The results of the MADIT-CRT Long-term International Follow-up Registry (MADIT-CRT LIFR) trial are based on a six-year follow-up in 549 mild heart failure patients enrolled in the MADIT-CRT study. In the original 1,820-patient trial, CRT-D was associated with a significant 34 percent reduction in the risk of heart failure or death over 2.4 years of follow-up compared to ICD alone. This benefit was sustained at long-term follow-up with rates of heart failure or death in 29 percent of patients in the CRT-D arm of the study versus 47 percent of patients who received ICD-only therapy (p<0.001).
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Further, the long-term benefit of CRT-D was found to be evident in left bundle branch block (LBBB) patients (HR=0.45 [95 percent CI 0.32-0.64]), "with continued separation in event rates throughout follow-up, and non-significant among non-LBBB patients (HR=0.82 [95 percent CI 0.46-1.48]; p-value for treatment-by-LBBB interaction = 0.04)."

"Our findings indicate that the clinical and echocardiographic benefits of cardiac resynchronization therapy in MADIT-CRT were sustained over an extended median follow-up period of > 6 years," wrote the authors. However, "the long-term benefit of cardiac resynchronization therapy in this population appears to be restricted to LBBB patients," they add.

Keywords: Follow-Up Studies, Electric Countershock, Heart Failure, Bundle-Branch Block, Defibrillators, Implantable, Cardiac Resynchronization Therapy, Echocardiography

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