http://www.theheart.org/web_slides/1136605.do A Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) with patients in NYHA class 1 or 2 with LVEF and ventricular dyssynchrony.

1. MADIT-CRT (Multicenter Automatic
Defibrillator Implantation Trial with
Cardiac Resynchronization Therapy)

2. MADIT-CRT (Multicenter Automatic Defibrillator
Implantation Trial with Cardiac Resynchronization Therapy)
AJ Moss (University of Rochester Medical Center, NY)
European Society of Cardiology 2009 Congress
• Population:
1820 patients in NYHA class 1 or 2, with LVEF <30% and ventricular
dyssynchrony—defined by an electrocardiographic QRS duration ≥130 ms
Patients with ischemic cardiomyopathy could be in NYHA class 1 or 2 and
those with nonischemic disease had to be in NYHA class 2
• Treatment:
Randomized 3:2 to receive a CRT-D device or an ICD only
Optimal medical therapy was required in both groups
• Primary outcome:
Death from any cause or nonfatal heart failure (HF) events
CRT-D=cardiac resynchronization therapy device
ICD=implantable cardioverter defibrillator

3. MADIT-CRT: Results
• The addition of resynchronization pacing cut the risk of death or heart-failure
events by about a third over two and a half years
HR (95%CI) for the primary end point and its components:
CRT-D patients (n=1089) vs ICD-only patients (n=731)a
End point All patients Patients with ischemic Patient with nonischemic
cardiomyopathy cardiomyopathy
Death or HF 0.66 (0.52–0.84)b 0.67 (0.52–0.88)c 0.62 (0.44–0.89)d
HF only 0.59 (0.47–0.74)b 0.58 (0.44–0.78)b 0.59 (0.41–0.87)d
Death 1.00 (0.69–1.44) 1.06 (0.68–1.64) 0.87 (0.44–1.70)
a. At a median of 2.4 years c. p=0.003
b, p≤0.001 d. p=0.01

4. MADIT-CRT: Commentary*
"The magnitude of the effect that we saw in this population is as big as what we
had seen in past years with beta blockers, as big as what we saw with ACE
inhibitors."
- Dr Angelo Auricchio
"I think for those physicians who have not accepted CRT, it's time."
- Dr Clyde W Yancy
"We have to understand which patients we should be doing this in, because it's an
expensive therapy. . . . And we have to ask, is there a cheaper way to keep people
out of the hospital than doing [CRT]?"
- Dr Mariell Jessup
*All comments from MADIT-CRT: Resynchronization therapy cuts heart-failure risk in patients with only
mild disease (http://www.theheart.org/article/997499.do)

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