Document Detail


Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT).
MedLine Citation:
PMID:  21357819     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background- This study aimed to determine whether QRS morphology identifies patients who benefit from cardiac resynchronization therapy with a defibrillator (CRT-D) and whether it influences the risk of primary and secondary end points in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) trial. Methods and Results- Baseline 12-lead ECGs were evaluated with regard to QRS morphology. Heart failure event or death was the primary end point of the trial. Death, heart failure event, ventricular tachycardia, and ventricular fibrillation were secondary end points. 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. The latter 2 groups were defined as non-LBBB groups. 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 risk of ventricular tachycardia, ventricular fibrillation, or death was decreased significantly in CRT-D patients with LBBB but not in non-LBBB patients. 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. Conclusions- Heart failure patients with New York Heart Association class I or II and ejection fraction ≤30% and LBBB derive substantial clinical benefit from CRT-D: a reduction in heart failure progression and a reduction in the risk of ventricular tachyarrhythmias. No clinical benefit was observed in patients with a non-LBBB QRS pattern (right bundle-branch block or intraventricular conduction disturbances). Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
Authors:
Wojciech Zareba; Helmut Klein; Iwona Cygankiewicz; W Jackson Hall; Scott McNitt; Mary Brown; David Cannom; James P Daubert; Michael Eldar; Michael R Gold; Jeffrey J Goldberger; Ilan Goldenberg; Edgar Lichstein; Heinz Pitschner; Mayer Rashtian; Scott Solomon; Sami Viskin; Paul Wang; Arthur J Moss;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-28
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-3-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Cardiology Division and Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY; The Hospital of the Good Samaritan, Los Angeles, CA; Cardiology Division, Duke University, Durham, NC; Cardiology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel; Cardiology Division, Medical University of South Carolina, Charleston, SC; Cardiology Division, Northwestern University, Chicago, IL; Maimonides Hospital, New York NY; Cardiology Division, Kerckhoff Medical University, Bad Neuheim, Germany; Foothill Cardiology, California Heart Medical Group, Pasadena, CA; Cardiology Division, Brigham and Women's Hospital, Harvard University, Boston, MA; Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and Cardiology Division, Stanford University, Stanford, CA.
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