Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials

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  • معلومة اضافية
    • Affiliation:
      National Heart & Lung Institute, Imperial College, London, United Kingdom
      Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
      Division of Cardiology, University of Washington, Seattle, Washington
    • Note:
      Drs. Sohaib, Finegold, Francis, and Whinnett are supported by the British Heart Foundation (FS/10/038, FS/13/44/30291, FS/11/92/29122, FS/14/25/30676). Dr. Nijjer is supported by the Medical Research Council (UK) (G1100443). Dr. Linde is supported by the Swedish Heart Lung Foundation (Grants 20080498 and 20110406) and the Stockholm County Council (Grants 20090376 and 20110610); was the principal investigator of REVERSE, a CRT study sponsored by Medtronic, Inc.; has received research grants, speaker honoraria, and consulting fees from Medtronic, Inc.; has received speaker honoraria and consulting fees from St. Jude Medical, Inc.; and is on the advisory board of Cardio 3. Dr. Levy has received research grants from the National Institutes of Health, Amgen, Thoratec, ResMed, Impulse Dynamics, Medtronic, Inc., and HeartWare, Inc.; is a consultant to Novartis, HeartWare, Inc., GE Healthcare, Magellan Health, and PharmIn; and holds equity in PharmIn. The University of Washington has received licensing for the Seattle Heart Failure Model from Impulse Dynamics, Thoratec, and Epocrates. Dr. Sutton holds a research grant from and is a consultant to Medtronic, Inc.; is on the Speakers Bureaus of Medtronic, Inc. and St Jude Medical, Inc.; and is a shareholder of Boston Scientific, Inc. and the American Society for Clinical Investigation. Dr. Francis is a consultant to Medtronic, Inc. and Sorin. Dr. Whinnett acts as a consultant to St. Jude Medical, Inc. and Medtronic, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
    • Keywords:
      cardiac resynchronization therapy
      heart failure
      QRS morphology
      survival
    • Abstract:
      Objectives This study examined the time course of clinical events in cardiac resynchronization therapy (CRT) trials.
    • Abstract:
      Methods The study identified all trials comparing CRT with no CRT, which reported Kaplan-Meier curves in groups defined by QRS: narrow, non–left bundle branch block (LBBB) broad, and LBBB broad. For each trial, the change in life span every 3 months up to 3.5 years (the longest time for which data are available) was calculated and a power law was fitted, that is, ∝ timen.
    • Abstract:
      Results Four trials (MADIT-CRT [Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy], RAFT [Resynchronization-Defibrillation for Ambulatory Heart Failure Trial], REVERSE [REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction], and EchoCRT [Echocardiography Guided Cardiac Resynchronization Therapy]), totaling 4,717 patients, reported curves for mortality or heart failure–related hospitalization, or for mortality. In patients with LBBB broad QRS (within MADIT-CRT), life span gain increased in proportion to time1.94. In contrast, in patients with non-LBBB broad QRS (within MADIT-CRT) and patients with narrow QRS (EchoCRT), life span was lost in proportion to time1.92 and time,1.96 respectively. Hospitalization-free survival showed similar patterns.
    • Abstract:
      Conclusions The nonlinear growth of life span gained when a CRT device is implanted in patients with LBBB broad QRS is unfortunately mirrored by a similarly progressive loss in life span in narrow QRS heart failure. This suggests the culprit is a progressive physiological effect of pacing rather than implant complications. If these data are not sufficient, a randomized controlled trial of deactivating CRT in patients with narrow QRS may now be needed, with a primary endpoint of increasing survival.
    • ISSN:
      2213-1779
    • Accession Number:
      10.1016/j.jchf.2014.11.007
    • Accession Number:
      S2213177915000220
    • Copyright:
      Copyright © 2015 American College of Cardiology Foundation Published by Elsevier Inc. All rights reserved.
  • Citations
    • ABNT:
      SOHAIB, S. M. A. et al. Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials. JACC: Heart Failure, [s. l.], v. 3, n. 4, p. 327–336, 2015. DOI 10.1016/j.jchf.2014.11.007. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S2213177915000220&custid=s8280428. Acesso em: 14 dez. 2019.
    • AMA:
      Sohaib SMA, Finegold JA, Nijjer SS, et al. Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials. JACC: Heart Failure. 2015;3(4):327-336. doi:10.1016/j.jchf.2014.11.007.
    • APA:
      Sohaib, S. M. A., Finegold, J. A., Nijjer, S. S., Hossain, R., Linde, C., Levy, W. C., … Whinnett, Z. I. (2015). Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials. JACC: Heart Failure, 3(4), 327–336. https://doi.org/10.1016/j.jchf.2014.11.007
    • Chicago/Turabian: Author-Date:
      Sohaib, S.M. Afzal, Judith A. Finegold, Sukhjinder S. Nijjer, Ruhella Hossain, Cecilia Linde, Wayne C. Levy, Richard Sutton, Prapa Kanagaratnam, Darrel P. Francis, and Zachary I. Whinnett. 2015. “Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials.” JACC: Heart Failure 3 (4): 327–36. doi:10.1016/j.jchf.2014.11.007.
    • Harvard:
      Sohaib, S. M. A. et al. (2015) ‘Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials’, JACC: Heart Failure, 3(4), pp. 327–336. doi: 10.1016/j.jchf.2014.11.007.
    • Harvard: Australian:
      Sohaib, SMA, Finegold, JA, Nijjer, SS, Hossain, R, Linde, C, Levy, WC, Sutton, R, Kanagaratnam, P, Francis, DP & Whinnett, ZI 2015, ‘Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials’, JACC: Heart Failure, vol. 3, no. 4, pp. 327–336, viewed 14 December 2019, .
    • MLA:
      Sohaib, S. M.Afzal, et al. “Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials.” JACC: Heart Failure, vol. 3, no. 4, Apr. 2015, pp. 327–336. EBSCOhost, doi:10.1016/j.jchf.2014.11.007.
    • Chicago/Turabian: Humanities:
      Sohaib, S.M. Afzal, Judith A. Finegold, Sukhjinder S. Nijjer, Ruhella Hossain, Cecilia Linde, Wayne C. Levy, Richard Sutton, Prapa Kanagaratnam, Darrel P. Francis, and Zachary I. Whinnett. “Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials.” JACC: Heart Failure 3, no. 4 (April 1, 2015): 327–36. doi:10.1016/j.jchf.2014.11.007.
    • Vancouver/ICMJE:
      Sohaib SMA, Finegold JA, Nijjer SS, Hossain R, Linde C, Levy WC, et al. Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing: Evidence From Randomized Controlled Trials. JACC: Heart Failure [Internet]. 2015 Apr 1 [cited 2019 Dec 14];3(4):327–36. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S2213177915000220&custid=s8280428