Electrical treatment of atrial arrhythmias in heart failure patients implanted with a dual defibrillator CRT device. Results from the TRADE-HF study

Giovanni Luca Botto, Luigi Padeletti, Gregorio Covino, Paolo Pieragnoli, Mattia Liccardo, Barbara Mariconti, Stefano Favale, Giulio Molon, Paolo De Filippo, Leonardo Bolognese, Maurizio Landolina, Giovanni Raciti, Giuseppe Boriani

Research output: Contribution to journalArticlepeer-review

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 6 months for 3 years 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. Conclusion 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.

Original languageEnglish
Pages (from-to)181-186
Number of pages6
JournalInternational Journal of Cardiology
Volume236
DOIs
Publication statusPublished - Jun 1 2017

Keywords

  • Atrial fibrillation
  • Dual defibrillator
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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