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A Randomized Study of Cardiac Resynchronization Therapy Defibrillator Versus Dual-Chamber Implantable Cardioverter-Defibrillator in Ischemic Cardiomyopathy With Narrow QRS
A Randomized Study of Cardiac Resynchronization Therapy Defibrillator Versus Dual-Chamber Implantable Cardioverter-Defibrillator in Ischemic Cardiomyopathy With Narrow QRS
- Source :
- Circulation: Arrhythmia and Electrophysiology. 6:538-545
- Publication Year :
- 2013
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2013.
-
Abstract
- Background— Current recommendations require a QRS duration of ≥120 ms as a condition for prescribing cardiac resynchronization therapy (CRT). This study was designed to test the hypothesis that patients with heart failure (HF) of ischemic origin, current indications for defibrillator implantation, and QRS Methods and Results— Patients with intraventricular dyssynchrony on echocardiography were randomly assigned to CRT or dual-chamber defibrillator implantation (CRT defibrillator and dual-chamber implantable cardioverter-defibrillator arm, respectively). The primary end point was the HF clinical composite response, which scores patients as improved, unchanged, or worsened. The secondary end point was the cumulative survival from HF hospitalization and HF death. An additional secondary end point was the composite of HF hospitalization, HF death, and spontaneous ventricular fibrillation. Twenty-three of 56 patients with CRT defibrillator showed an improvement in their clinical composite response at 1 year, compared with 9 of 55 patients with dual-chamber implantable cardioverter-defibrillator (41% versus 16%; P =0.004). After a median follow-up of 16 months, the CRT defibrillator arm showed a nonsignificant higher survival from HF hospitalization and HF death ( P =0.077), and a significantly higher survival from the combined end point of HF hospitalization, HF death, and spontaneous ventricular fibrillation ( P =0.028). Conclusions— In this comparison of CRT defibrillator and dual-chamber implantable cardioverter-defibrillator, CRT improved clinical status in some patients with ischemic cardiomyopathy, mild-to-moderate symptoms, narrow QRS duration, and mechanical dyssynchrony on echocardiography. Clinical Trial Registration— URL: http://clinicaltrials.gov . Unique identifier: NCT01577446.
- Subjects :
- Male
medicine.medical_specialty
dyssynchrony
medicine.medical_treatment
Myocardial Ischemia
Cardiac resynchronization therapy
Kaplan-Meier Estimate
Risk Assessment
Statistics, Nonparametric
law.invention
Cardiac Resynchronization Therapy
Electrocardiography
Ventricular Dysfunction, Left
QRS complex
narrow qr
Randomized controlled trial
law
Physiology (medical)
Internal medicine
Clinical endpoint
Humans
Medicine
cardiovascular diseases
Prospective Studies
Heart Failure
Ischemic cardiomyopathy
business.industry
Cardiac Pacing, Artificial
Implantable cardioverter-defibrillator
medicine.disease
Echocardiography, Doppler
Defibrillators, Implantable
Survival Rate
Treatment Outcome
Heart failure
Ventricular fibrillation
cardiovascular system
Tachycardia, Ventricular
Cardiology
Female
Cardiomyopathies
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 19413084 and 19413149
- Volume :
- 6
- Database :
- OpenAIRE
- Journal :
- Circulation: Arrhythmia and Electrophysiology
- Accession number :
- edsair.doi.dedup.....0a181f8c19627623235e2a329192cd7f
- Full Text :
- https://doi.org/10.1161/circep.113.000135