title: Effect of cardiac resynchronization therapy on the risk of ventricular tachyarrhythmias in patients with chronic kidney disease.
abstract: BACKGROUND
  The effect of chronic kidney disease (CKD) on benefit from cardiac resynchronization therapy with defibrillator (CRT-D) in reducing ventricular tachyarrhythmia (VTA) risk among mild heart failure (HF) patients is not well understood.
  
  
  METHODS
  We evaluated the impact of baseline renal function on VTAs in 1274 left bundle branch block (LBBB) patients enrolled in MADIT-CRT. Two prespecified subgroups were created based on estimated glomerular filtration rate (GFR): GFR <60 (n = 413) and GFR ≥60 ml/min/1.73 m2(n = 861). Primary end point was ventricular tachycardia/ventricular fibrillation/death (VT/VF/death). Secondary end points were any VT/VF and ventricular tachycardia ≥ 200 bpm or VF (fast VT/VF).
  
  
  RESULTS
  There were 413 (32%) LBBB patients presenting with CKD, primarily of moderate severity (GFR mean 48.1 ± 8.3). For patients with and without CKD, CRT-D was associated with lower risk of the primary end point (GFR<60: HR = 0.61, 95% CI: 0.41-0.89, p = .010; GFR≥60: HR = 0.58, 95% CI: 0.52-0.89, p = .005), relative to ICD-only treatment. For patients in both renal function categories, CRT-D in comparison to ICD alone was associated with lower risk of VT/VF (GFR<60: HR = 0.68, 95% CI: 0.42-1.10, p = .113; GFR≥60: HR = 0.65, 95% CI: 0.48-0.88, p = .005) and fast VT/VF (GFR<60: HR = 0.49, 95% CI: 0.25-0.96, p = .038; GFR≥60: HR = 0.55, 95% CI: 0.39-0.80, p = .001), when accounting for competing mortality risk. This effect was independent of CRT-induced reverse remodeling.
  
  
  CONCLUSIONS
  Among mild HF patients with LBBB, those with and without CKD both derived benefit from CRT-D in risk reduction in VTAs, independent of cardiac reverse remodeling.
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Usama A
authors.initials: UA
authors.lastname: Daimee
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Yitschak
authors.initials: Y
authors.lastname: Biton
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Hospital of the Good Samaritan, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cannom
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Helmut
authors.initials: H
authors.lastname: Klein
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Ruwald
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Wang
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000175:diagnosis* / Q000517:prevention & control; D016896:Treatment Outcome
keywords: cardiac resynchronization therapy; chronic kidney disease; heart failure; ventricular tachyarrhythmias