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Frequency and Outcomes of Postrandomization Atrial Tachyarrhythmias in the Resynchronization/Defibrillation in Ambulatory Heart Failure Trial.
- Source :
- Circulation: Arrhythmia & Electrophysiology; May2016, Vol. 9 Issue 5, p1-9, 9p
- Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>Whether adding cardiac resynchronization therapy (CRT-D) to an implanted cardioverter-defibrillator alters the risk of atrial fibrillation or other atrial tachyarrhythmias (AF/AT), or if postimplantation AF/AT modulate the benefits of CRT-D, remain unknown.<bold>Methods and Results: </bold>We studied 972 Resynchronization/Defibrillation in Ambulatory Heart Failure Trial (RAFT) participants without permanent AF, who were randomized to CRT-D (n=495) versus nonresynchronization defibrillator (implanted cardioverter-defibrillator; n=477) within the predefined stratum eligible for an atrial lead. Occurrence of postrandomization AF/AT was prospectively assessed, and Cox models were used to test the independent association between the postrandomization AF/AT and the RAFT primary composite outcome of all-cause mortality or hospitalization for heart failure. Over 41 (±19) months, postrandomization AF/AT occurred in 216 (45.3%) patients randomized to implanted cardioverter-defibrillator and 249 (50.3%) randomized to CRT-D. After adjusting for competing risk of death, randomization to CRT-D increased risk of postrandomization AF/AT (hazard ratio, 1.20; 95% confidence interval, 1.00-1.42; P=0.045). Postrandomization AF/AT, which remained paroxysmal in 69.5%, did not reduce biventricular pacing percentage. In adjusted models, postrandomization AF/AT was not associated with the primary outcome (hazard ratio, 1.04; 95% confidence interval, 0.84-1.30). However, AF/AT was associated with a borderline decreased risk of mortality (hazard ratio, 0.75; 95% confidence interval, 0.58-1.00) but increased risk of heart failure hospitalization (hazard ratio, 1.43; 95% confidence interval, 1.08-1.90).<bold>Conclusions: </bold>In RAFT, nearly half of the patients developed postrandomization AF/AT, and those randomized to CRT-D had borderline significant higher risk. Postrandomization AF/AT was associated with risk of heart failure hospitalization, but not with the primary composite outcome.<bold>Clinical Trial Registration: </bold>URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251. [ABSTRACT FROM AUTHOR]
- Subjects :
- HEART failure treatment
CARDIAC pacing
COMPARATIVE studies
ELECTRIC countershock
ELECTROCARDIOGRAPHY
HEART atrium
HEART failure
LONGITUDINAL method
RESEARCH methodology
MEDICAL cooperation
PROGNOSIS
RESEARCH
RESEARCH funding
TIME
EVALUATION research
RANDOMIZED controlled trials
TREATMENT effectiveness
DISEASE incidence
SUPRAVENTRICULAR tachycardia
Subjects
Details
- Language :
- English
- ISSN :
- 19413149
- Volume :
- 9
- Issue :
- 5
- Database :
- Supplemental Index
- Journal :
- Circulation: Arrhythmia & Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 115449743
- Full Text :
- https://doi.org/10.1161/CIRCEP.115.003807