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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT; Moss AJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009] trial evaluated the effect of CRT with biventricular pacing on the combined endpoint of death from any cause and nonfatal heart failure (HF) events in 1820 patients with mild HF. The benefit of a CRT plus ICD (CRT-D) was driven by a 41% reduction in the risk of nonfatal HF events and was observed only in patients with left bundle-branch block [Zareba W et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011]. The aim of the long-term follow-up analysis [Goldenberg I et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2014] was to prospectively assess the effect of CRT-D on long-term survival.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT; Moss AJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009] trial evaluated the effect of CRT with biventricular pacing on the combined endpoint of death from any cause and nonfatal heart failure (HF) events in 1820 patients with mild HF. Eligible patients had ischemic or nonischemic cardiomyopathy with NYHA Class I or II symptoms, an ejection fraction of \u226430%, and a QRS duration of \u2265130 msec. At a median follow-up of 2.4 years, the primary endpoint occurred in 17.2% of patients who received a CRT plus an implantable cardioverter defibrillator (ICD) compared with 25.3% of patients who received an ICD alone (HR, 0.66; 95% CI, 0.52 to 0.84; p=0.001). The benefit of a CRT plus ICD (CRT-D) was driven by a 41% reduction in the risk of nonfatal HF events and was observed only in patients with left bundle-branch block (LBBB) [Zareba W et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBecause a survival benefit was not demonstrated for CRT-D during the MADIT-CRT trial, the aim of the long-term follow-up analysis [Goldenberg I et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2014], presented by Ilan Goldenberg, MD, University of Rochester Medical Center, Rochester, New York, USA, was to prospectively assess the effect of CRT-D on long-term survival.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAll of the surviving MADIT-CRT trial patients (n=1691) participated in Phase 1 of the long-term follow-up until September 10, 2010. Of these, 854 were included in the Phase 2 registry and followed until September 30, 2013. The primary endpoint was all-cause mortality from MADIT-CRT enrollment until post-trial follow-up. Secondary endpoints included nonfatal HF events and a combined endpoint of a nonfatal HF event or death. The analyses were performed on an intention-to-treat basis and by LBBB status at enrollment.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOverall after 7 years of follow-up, 292 patients (16%) had died and 442 patients (24%) had experienced a nonfatal HF event. Among patients \u003Cem\u003Ewith\u003C\/em\u003E LBBB, the all-cause mortality rate among was 18% in the CRT-D group compared with 29% in the ICD-only group (adjusted HR, 0.59; 95% CI, 0.43 to 0.80; p\u0026lt;0.001; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Patients in the CRT-D group also had a significantly lower probability of nonfatal HF events than the ICD-only group (adjusted HR, 0.38; 95% CI, 0.30 to 0.48; p\u0026lt;0.001) and the composite endpoint of HF or death (adjusted HR, 0.45; 95% CI, 0.37 to 0.56; p\u0026lt;0.001).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15824\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15824\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15824\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EMultivariate Analysis of Survival Benefit with CRT-D by LBBB Status\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EAmong patients \u003Cem\u003Ewithout\u003C\/em\u003E LBBB, CRT-D provided no benefit (possibly harm) over ICD-only for all-cause mortality (adjusted HR, 1.57; 95% CI, 1.03 to 2.39; p=0.04), nonfatal HF events (adjusted HR, 1.13; 95% CI, 0.80 to 1.60; p=0.48), and the combined endpoint of HF or death (adjusted HR, 1.27; 95% CI, 0.94 to 1.73; p\u0026lt;0.001).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ENo subgroup with LBBB demonstrated worse survival when treated with CRT-D versus CRT alone. Patients with LBBB benefited from CRT-D regardless of QRS duration (QRS 130 to \u0026lt;150 msec or \u2265150 msec), while those without LBBB did not benefit from CRT-D regardless of QRS duration.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Goldenberg concluded that early intervention with CRT-D compared with ICD-only is associated with a significant long-term survival benefit in patients with mild HF symptoms, left ventricular dysfunction, and LBBB. However, early CRT-D intervention does not benefit patients without LBBB and may be harmful.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/4\/19.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzpbq2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzpbq2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}