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  • Title: Clinical significance of ventricular tachyarrhythmias in patients treated with CRT-D.
    Author: Kutyifa V, Klein HU, Wang PJ, McNitt S, Polonsky B, Zima E, Merkely B, Moss AJ, Zareba W.
    Journal: Heart Rhythm; 2013 Jul; 10(7):943-50. PubMed ID: 23639624.
    Abstract:
    BACKGROUND: Data on the outcome of cardiac resynchronization therapy with defibrillator (CRT-D) in patients developing ventricular arrhythmias are limited. OBJECTIVE: To evaluate the prognostic value of ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes by heart rate in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy trial. METHODS: Slow VT was defined as VTs with heart rate < 200 beats/min. Fast VT with a heart rate ≥200 beats/min and VF (>250 beats/min) were considered as a combined category. Primary end point was heart failure (HF) or death. Secondary end point included all-cause mortality. RESULTS: There were 228 (12.7%) patients with slow VT and 198 (11.1%) with fast VT/VF. In time-dependent analysis, slow VT was associated with an increased risk of HF/death in CRT-D patients with left branch bundle block (LBBB; hazard ratio [HR] 3.19; 95% confidence interval [CI] 1.83-5.55; P < .001), but not in patients with implantable cardioverter-defibrillator (ICD) (HR 1.03; 95% CI 0.52-2.19; P = .867; interaction P value = .017). CRT-D patients with LBBB and fast VT/VF doubled their risk of HF/death compared to ICD patients (interaction P value = .06). Slow VT events were also predictive of death in CRT-D patients with LBBB (HR 3.48; 95% CI 1.66-7.28; P < .001), but not in ICD patients (interaction P value = .06). Slow VTs were highly predictive of subsequent fast VT/VF (HR 4.33; 95% CI 3.01-6.24; P < .001). CONCLUSIONS: Slow VT episodes are predictive of subsequent fast VT/VF. Slow VT and fast VT/VF episodes in CRT-D patients are associated with an increased risk of subsequent HF/death. CRT-D-treated LBBB patients with slow VTs have a significantly higher risk of mortality.
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