Response of right ventricular size to treatment with cardiac resynchronization therapy and the risk of ventricular tachyarrhythmias in MADIT-CRT

Abstract

Background: Cardiac resynchronization therapy (CRT) is increasingly recognized for its ability to reduce ventricular tachyarrhythmias, possibly associated with left ventricular reverse remodeling, but the role of the right ventricle (RV) in this process has not been examined.

Objective: The purpose of this study was to investigate the relationship between ventricular tachyarrhythmias and change in RV dimensions in patients receiving CRT with a defibrillator (CRT-D).

Methods: Multivariate Cox proportional hazards regression modeling was used to assess the risk for fast (≥180 bpm) ventricular tachycardia/ventricular fibrillation (VT/VF) or death by baseline and follow-up RV size (defined as right ventricular end-diastolic area [RVEDA]) among 1495 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT).

Results: Multivariate analysis showed that treatment with CRT-D was independently associated with a 27% (P = .003) reduction in the risk of VT/VF or death among patients with larger RVs (>first quartile RVEDA ≥13 mm(2)/m(2)) compared with implantable cardioverter-defibrillator (ICD)-only therapy, whereas in patients with smaller RVs there was no significant difference in the risk of VT/VF between the 2 treatment arms (hazard ratio = 1.00, P = .99). At 1-year follow-up, CRT-D patients displayed significantly greater reductions in RVEDA compared to ICD-only patients (P <.001), associated with a corresponding reduction in the risk of subsequent VT/VF or death (>first quartile reduction in RVEDA with CRT-D vs ICD-only: hazard ratio = 0.55, P <.001) independent of changes in left ventricular dimensions.

Conclusion: Our findings suggest that the RV may have an important role in determining the antiarrhythmic effect of CRT independent of the effect of the device on the left ventricle.

Keywords: BSA; CI; CRT; CRT-D; Cardiac remodeling; Cardiac resynchronization therapy; HR; ICD; LV; MADIT-CRT; Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy; NYHA; New York Heart Association; RV; RVEDA; RVFAC; Right ventricle; Right ventricular size; VF; VT; Ventricular fibrillation; Ventricular tachycardia; body surface area; cardiac resynchronization therapy; cardiac resynchronization therapy defibrillator; confidence interval; hazard ratio; implantable cardioverter-defibrillator; left ventricle; right ventricle; right ventricular end-diastolic area; right ventricular fractional area change; ventricular fibrillation; ventricular tachycardia.