title: Electrical treatment of atrial arrhythmias in heart failure patients implanted with a dual defibrillator CRT device. Results from the TRADE-HF study.
abstract: BACKGROUND
  Ventricular and atrial arrhythmias commonly occur in heart failure patients and are a significant source of symptoms, morbidity and mortality. Some specific generators referred to as dual defibrillators, Dual CRT-Ds, have the ability to treat atrial and ventricular arrhythmias. TRADE-HF is a prospective two-arm randomized study aimed at assessing the benefits of complete automatic management of atrial arrhythmias in patients implanted with a dual CRT-D.
  
  
  METHODS
  Primary objective of the TRADE-HF study was to document reduction of unplanned hospital admission for cardiac reasons or death for cardiovascular causes or progression to permanent AF, by comparing fully-automatic device driven therapy for atrial tachycardia or fibrillation (AT/AF) to an in-hospital approach for treatment of symptomatic AT/AF. Randomized Patients were followed every 6months for 3years to assess the primary objective.
  
  
  RESULTS
  Four-hundred-twenty patients have been enrolled in the study. At the end of the study 30 subjects died for cardiovascular causes, 60 had at least one hospitalization for cardiovascular causes and 14 developed permanent AF. Eighty-seven patients experienced a composite event. Hazard Ratio for device-managed automatic therapy arm compared to traditional was 0.987 (95% CI: 0.684-1.503; p=0.951). The primary endpoint analysis resulted in no difference between the device managed and in-hospital treatment arm.
  
  
  CONCLUSIONS
  The TRADE-HF study failed to demonstrate a reduction in the composite of unplanned hospitalizations for cardiovascular causes or death for cardiovascular causes or progression to permanent AF using automatic atrial therapy compared to a traditional approach including hospitalization for symptomatic episodes and/or in-hospital treatment of AT/AF.
authors.affiliation: Cardiology Dept., Sant'Anna Hopsital, S. Fermo Della Battaglia, Italy. Electronic address: gluca.botto@gmail.com.
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Botto
authors.affiliation: Cardiology Dept., Careggi Hospital, University of Firenze, Firenze, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.affiliation: Cardiology Dept., S Giovanni Bosco Hospital, Napoli, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Covino
authors.affiliation: Cardiology Dept., Careggi Hospital, University of Firenze, Firenze, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pieragnoli
authors.affiliation: Cardiology Dept., S. Maria delle Grazie Hospital, Pozzuoli, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Liccardo
authors.affiliation: Cardiology Dept., Sant'Anna Hopsital, S. Fermo Della Battaglia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mariconti
authors.affiliation: Cardiology Dept., Policlinico Consorziale Hospital, University of Bari, Bari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Favale
authors.affiliation: Cardiology Dept., Sacro Cuore Hospital, Negrar, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.affiliation: Cardiology Dept., Ospedali Riuniti, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Filippo
authors.affiliation: Cardiology Dept., S. Donato Hospital, Arezzo, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.affiliation: Cardiology Dept., S. Matteo Hospital, Pavia, Italy and Ospedale Maggiore, Crema, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.affiliation: Boston Scientific Corporation, United States.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raciti
authors.affiliation: Cardiology Dept., DIMES Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy and Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine. University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000639:trends*; D017147:Defibrillators, Implantable / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Atrial fibrillation; Dual defibrillator; Heart failure