Related Experiment Video
Updated: Jun 6, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Time-dependent benefit of preventive cardiac resynchronization therapy after myocardial infarction
Alon Barsheshet1, Arthur J Moss, Michael Eldar
1Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA. alon.barsheshet@heart.rochester.edu
Insights
The time elapsed since myocardial infarction (MI) impacts the effectiveness of cardiac resynchronization therapy with defibrillator (CRT-D). Longer intervals post-MI correlate with greater CRT-D benefits for patients with ischaemic cardiomyopathy.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac remodeling is a progressive consequence of myocardial infarction (MI).
- The influence of time elapsed since MI on the efficacy of cardiac resynchronization therapy with defibrillator (CRT-D) remains uncharacterized.
- Ischaemic cardiomyopathy (ICM) patients represent a significant population for CRT-D therapy.
Purpose of the Study:
- To investigate the relationship between the time elapsed since MI and the benefits of preventive CRT-D therapy in patients with ICM.
- To determine if the temporal relationship between MI and CRT-D implantation affects patient outcomes.
Main Methods:
- Analysis of data from 704 ICM patients with documented MI from the MADIT-CRT trial, and a separate cohort of 237 ICM patients without prior MI.
- Assessed the risk of heart failure (HF) or death based on elapsed time from MI, comparing CRT-D with implantable cardioverter defibrillator (ICD)-only therapy.
- Utilized multivariate analysis to evaluate the interaction between elapsed time from MI and CRT-D benefit.
Main Results:
- In ICD-only patients, the risk of HF or death increased by 4% for each year post-MI.
- Patients with remote MI (≥8 years) experienced significantly greater benefit from CRT-D (HR=0.42) compared to those with recent MI (HR=1.26).
- CRT-D benefit demonstrated a direct correlation with increasing time elapsed from MI, with substantial benefits observed in patients ≥8 years post-MI and those without prior MI.
Conclusions:
- The time elapsed since myocardial infarction is a critical factor influencing both the risk of heart failure or death and the magnitude of benefit derived from CRT-D in patients with ICM.
- These findings suggest that the temporal profile of MI should be considered when selecting ICM patients for CRT-D therapy.
Aims:
Cardiac remodelling is a progressive process after myocardial infarction (MI). However, currently there are no data regarding the effect of s:elapsed time from MI on the benefit of cardiac resynchronization therapy with defibrillator (CRT-D). The present study was designed to evaluate the relationship between elapsed time from MI and the benefit of preventive CRT-D therapy in patients with ischaemic cardiomyopathy (ICM).
Methods And Results:
The risk of heart failure (HF) or death as a function of elapsed time from MI to enrolment, by treatment with CRT-D vs. implantable cardioverter defibrillator (ICD)-only therapy, was assessed among 704 ICM patients with a documented MI enrolled in MADIT-CRT, and separately in a subset of ICM patients without a documented prior MI (n = 237). In ICD patients, the adjusted risk of HF or death increased by 4% (P = 0.01) for each year elapsed from MI. Multivariate analysis demonstrated that patients with remote MI [categorized at the median value (≥8 years)] derived a significantly greater benefit from CRT-D [HR = 0.42 (P < 0.001)] than those with a more recent MI [HR = 1.26 (P = 0.35); P-value for interaction <0.001]. Consistently, the benefit of CRT-D was directly related to increasing quartiles of elapsed time from MI [Q(1) (<3 years): HR = 1.67; P = 0.20, Q(2) (3-8 years): HR = 1.12; P = 0.71, Q(3) (8-15 years): HR = 0.47; P = 0.02, and Q(4) (≥15 years): HR = 0.38; P = 0.001]. The ICM subgroup with no documented MI also derived enhanced benefit from CRT-D (HR = 0.43; P = 0.003).
Conclusion:
In patients with ischaemic cardiomyopathy, the risk of HF or death and the magnitude of CRT-D benefit are directly related to elapsed time from MI.
More Related Videos
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care