PR Interval identifies clinical response in patients with non-left bundle branch block a multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy substudy

Valentina Kutyifa, Martin Stockburger, James P. Daubert, Fredrik Holmqvist, Brian Olshansky, Claudio Schuger, Helmut Klein, Ilan Goldenberg, Andrew Brenyo, Scott McNitt, Bela Merkely, Wojciech Zareba, Arthur J. Moss

Research output: Article

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Abstract

Background :In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADITCRT), patients with non-left bundle branch block (LBBB; including right bundle branch block, intraventricular conduction delay) did not have clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D). We hypothesized that baseline PR interval modulates clinical response to CRT-D therapy in patients with non-LBBB.Methods and Results :Non-LBBB patients (n=537; 30%) were divided into 2 groups based on their baseline PR interval as normal (including minimally prolonged) PR (PR <230 ms) and prolonged PR (PR =230 ms). The primary end point was heart failure or death. Separate secondary end points included heart failure events and all-cause mortality. Cox proportional hazards regression models were used to compare risk of end point events by CRT-D to implantable cardioverter defibrillator therapy in the PR subgroups. There were 96 patients (22%) with a prolonged PR and 438 patients (78%) with a normal PR interval. In non-LBBB patients with a prolonged PR interval, CRT-D treatment was associated with a 73% reduction in the risk of heart failure/death (hazard ratio, 0.27; 95% confidence interval, 0.13-0.57; P<0.001) and 81% decrease in the risk of all-cause mortality (hazard ratio, 0.19; 95% confidence interval, 0.13-0.57; P<0.001) compared with implantable cardioverter defibrillator therapy. In non-LBBB patients with normal PR, CRT-D therapy was associated with a trend toward an increased risk of heart failure/death (hazard ratio, 1.45; 95% confidence interval, 0.96-2.19; P=0.078; interaction P<0.001) and a more than 2-fold higher mortality (hazard ratio, 2.14; 95% confidence interval, 1.12-4.09; P=0.022; interaction P<0.001) compared with implantable cardioverter defibrillator therapy.Conclusions :The data support the use of CRT-D in MADIT-CRT non-LBBB patients with a prolonged PR interval. In non-LBBB patients with a normal PR interval, implantation of a CRT-D may be deleterious.Clinical Trial Registration :http://clinicaltrials.gov; Unique Identifier: NCT00180271. (Circ Arrhythm Electrophysiol. 2014;7:645-651.)

Original languageEnglish
Pages (from-to)645-651
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number4
DOIs
Publication statusPublished - aug. 1 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Kutyifa, V., Stockburger, M., Daubert, J. P., Holmqvist, F., Olshansky, B., Schuger, C., Klein, H., Goldenberg, I., Brenyo, A., McNitt, S., Merkely, B., Zareba, W., & Moss, A. J. (2014). PR Interval identifies clinical response in patients with non-left bundle branch block a multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy substudy. Circulation: Arrhythmia and Electrophysiology, 7(4), 645-651. https://doi.org/10.1161/CIRCEP.113.001299