March 30th, 2014
Long-Term Follow-Up from MADIT-CRT: Guideline Implications
CardioExchange’s John Ryan interviews Arthur J. Moss about his research group’s study of long-term survival for patients who received cardiac resynchronization therapy with a defibrillator (CRT-D) in the MADIT-CRT trial. The findings were presented at ACC.14 and published simultaneously in The New England Journal of Medicine.
Seven-year follow-up in the MADIT-CRT trial was tracked, on an intention-to-treat basis, for all 1691 surviving participants and, subsequently, for 854 participants who were enrolled in post-trial registries. The cumulative all-cause mortality rate among patients with left bundle-branch block (LBBB) was significantly lower in the CRT-D group than in the defibrillator-alone group (18% vs. 29%). However, in patients without LBBB, CRT-D had no benefit and showed possible harm.
Ryan: Your results are very impressive. Will they compel us to change our practice and offer CRT-D to patients who have asymptomatic or mild congestive heart failure?
Moss: On the basis of data from our prior studies and publications (N Engl J Med 2010; 363:2385; MADIT-CRT), CRT-D is already approved for patients with asymptomatic or mild heart failure, a reduced LV ejection fraction, and a left bundle-branch block (LBBB) conduction disturbance. The current findings published in the NEJM strengthen the guideline indications, given the significant reduction in all-cause mortality during long-term (7-year) follow-up with CRT-D treatment in these patients.
Ryan: The 2013 heart failure guidelines list CRT as a class IIa recommendation for patients who have a “non-LBBB pattern with a QRS duration of >150 msec.” Given your findings, should this recommendation be revisited?
Moss: The 2013 heart failure guidelines should be revised because our original trial results from 2010 showed no benefit of CRT-D in reducing the incidence of heart failure in patients with a non-LBBB pattern even with a wide QRS duration >150 msec. Findings from our current trial show no evidence of mortality reduction during long-term follow-up.
Share your thoughts on Dr. Moss’ analysis of the long-term results from MADIT-CRT.
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