15 In this large trial of 1820 patients, CRT-D therapy was associated with a significant 34% reduction of risk of a heart failure event or death compared with ICD therapy. The benefits of CRT-D were investigated recently in NYHA class I and II heart failure patients with a wide QRS complex who were enrolled in the Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT). 4, 7, 8 Among patients treated with CRT, those with significant QRS prolongation (>150 ms) appear to derive the most benefit, although in most of the studies, there was not sufficient statistical power to document statistically significant interactions of CRT effectiveness with QRS >150ms. 1 – 8 CRT is currently approved for patients with advanced heart failure (New York Heart Association class III and IV) and a wide QRS complex, and these patients derive significant benefit from this therapy, which results in a reduction of risk of heart failure hospitalizations and deaths, in addition to improvement in patients' functional status. Echocardiographic parameters showed significantly ( P<0.001) greater reduction in left ventricular volumes and increase in ejection fraction with CRT-D in LBBB than in non-LBBB patients.Ĭurrent recommendations regarding clinical management of systolic heart failure include device therapy consisting of an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) with a defibrillator (CRT-D) combined with optimal pharmacological therapy according to broadly approved guidelines that are based on results of major clinical trials. The risk of ventricular tachycardia, ventricular fibrillation, or death was decreased significantly in CRT-D patients with LBBB but not in non-LBBB patients. Hazard ratios for the primary end point for comparisons of CRT-D patients versus patients who only received an implantable cardioverter defibrillator (ICD) were significantly ( P<0.001) lower in LBBB patients (0.47 P<0.001) than in non-LBBB patients (1.24 P=0.257). The latter 2 groups were defined as non-LBBB groups. Among 1817 patients with available sinus rhythm ECGs at baseline, there were 1281 (70%) with left bundle-branch block (LBBB), 228 (13%) with right bundle-branch block, and 308 (17%) with nonspecific intraventricular conduction disturbances. Death, heart failure event, ventricular tachycardia, and ventricular fibrillation were secondary end points. Heart failure event or death was the primary end point of the trial. Customer Service and Ordering Informationīaseline 12-lead ECGs were evaluated with regard to QRS morphology.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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