Heart failureLong-Term Survival of Patients With Heart Failure and Ventricular Conduction Delay Treated With Cardiac Resynchronization Therapy
Section snippets
Patients
One thousand three hundred three adult patients with moderate to severe HF caused by left ventricular systolic dysfunction (ejection fraction ≤35%) of ischemic or nonischemic origin and with ventricular conduction delay (QRS duration ≥120 ms) treated with CRT were included. All patients were consecutively treated from August 1, 1995 to August 1, 2004 at 4 European institutions using a prospectively predefined registry protocol. Patients were referred because of persistent HF symptoms despite
Patient characteristics
Outcome information could not be retrieved in 5 patients who were therefore excluded from further analysis. Characteristics of the 1,298 patients are presented in Table 1. Origin was confirmed in all patients by coronary angiography, and the cause of HF was coronary artery disease in 54% of patients. Each patient was on a median of 4 active cardiovascular drugs. About 75% of patients presented with left bundle branch block QRS morphology, and 15% of patients had been constantly paced due to
Discussion
This is the first large, long-term, prospectively defined observational study on CRT in symptomatic patients with moderate to severe HF and ventricular conduction delay. Our results extend those of previous, randomized, controlled studies of CRT on mortality5, 6, 7 showing a very favorable outcome of patients treated with CRT in real-world clinical practice. Cumulative event-free survivals were 92% and 56% at 1 and 5 years, respectively, with a high consistency across the 4 European centers.
References (23)
- et al.
Long-term clinical effect of hemodynamically optimized CRT in patients with heart failure and ventricular conduction delay
J Am Coll Cardiol
(2002) - et al.
Classification of death in antiarrhythmic trials
J Am Coll Cardiol
(1996) - et al.
Long term efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation
J Am Coll Cardiol
(2006) - et al.
Left bundle branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian Network on Congestive Heart Failure Investigators
Am Heart J
(2002) - et al.
Randomized, controlled trials, observational studies and the hierarchy of research designs
N Engl J Med
(2000) - et al.
A comparison of observational studies and randomized, controlled trials
N Engl J Med
(2000) - et al.
Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay
Circulation
(1999) - et al.
Cardiac resynchronization in chronic heart failure
N Engl J Med
(2002) - et al.
Cardiac resynchronisation therapy with or without an implantable defibrillator in advanced chronic heart failure
N Engl J Med
(2004) - et al.
The effect of CRT on morbidity and mortality in heart failure
N Engl J Med
(2005)
Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology
Eur Heart J
Cited by (87)
Deep Natural Language Processing to Identify Symptom Documentation in Clinical Notes for Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy
2020, Journal of Pain and Symptom ManagementCitation Excerpt :CRT is an established therapy for patients with both severe HFrEF and dyssynchronous ventricular activation,8–11 the latter of which is associated with reduced cardiac output and increased mortality.8,9,12,13 CRT leads to increased left ventricular ejection fraction (LVEF), decreased heart failure-related hospitalizations, improved survival, and higher quality of life in some, but not all patients.14–22 Identifying the patients who are most likely to benefit and the optimal timing for CRT insertion remain challenging.
Comparison between cardiac resynchronization therapy with and without defibrillator on long-term mortality: A propensity score matched analysis
2020, Journal of CardiologyCitation Excerpt :In the meanwhile, observational studies yielded conflicting results. An early report by the Multicenter Longitudinal Observational Study Group, which included 1060 patients with a median follow-up of 34 months, showed no difference in mortality between CRT-D and CRT-P groups at multivariable analysis [6]. However, Bai et al. reported survival benefit of CRT-D over CRT-P in a population of 542 patients after a median follow-up of 811 days, and implantation of CRT-D was independently associated with lower mortality in the multivariate regression analysis [7].
Chronotropic Incompetence and Pacing in HPEF Heart Failure with Preserved Ejection Fraction
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection FractionAtrial Fibrillation Ablation Should Be First-Line Therapy in Heart Failure Patients: CON
2019, Cardiology ClinicsRole of Atrioventricular Junctional Ablation and Cardiac Resynchronization Therapy in Patients with Chronic Atrial Fibrillation
2019, Cardiac Electrophysiology ClinicsCitation Excerpt :In addition, common clinical practice applies CRT to patients with persistent atrial fibrillation (AF). Specifically in the population of patients with HF undergoing CRT, the prevalence of AF is substantial.3–5 The 2011 US National Cardiovascular Data indicated that 36% of 87,692 patients with cardiac resynchronization therapy-defibrillator (CRT-D) had AF, and in 2012, 31% of 326,000 patients with an implantable cardioverter defibrillator (ICD) had AF.6
What happens to non-responders in cardiac resynchronization therapy?
2017, Revista Portuguesa de Cardiologia