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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

Authors :
Raffaele Iengo
Francesco Solimene
Igor Diemberger
Maurizio Nastasi
Raimondo Calvanese
Michelangelo Canciello
Concetto La Rosa
Carmine Muto
Carmine Ciardiello
Raffaele Sangiuolo
Bernardino Tuccillo
Paolo Gallo
C. Muto
F. Solimene
P. Gallo
M. Nastasi
C. La Rosa
R. Calvanese
R. Iengo
M. Canciello
R. Sangiuolo
I. Diemberger
C. Ciardiello
B. Tuccillo
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.

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