In patients with NICM, CRT-D was superior to CRT-P in +MWF but not -MWF. These findings have implications for the choice of device therapy in patients with NICM.

BackgroundPredicting clinical outcomes after cardiac resynchronization therapy (CRT) and its optimization remain a challenge. We sought to determine whether pre‐ and postimplantation QRS area (QRS area) predict clinical outcomes after CRT.Methods and ResultsIn this retrospective study, QRS area, derived from pre‐ and postimplantation vectorcardiography, were assessed in relation to the primary end point of cardiac mortality after CRT with or without defibrillation. Other end points included total mortality, total mortality or heart failure (HF) hospitalization, total mortality or major adverse cardiac events, and the arrhythmic end point of sudden cardiac death or ventricular arrhythmias with or without a shock. In patients (n=380, age 72.0±12.4 years, 68.7% male) undergoing CRT over 7.7 years (median follow‐up: 3.8 years [interquartile range 2.3–5.3]), preimplantation QRS area ≥102 μVs predicted cardiac mortality (HR: 0.36; P<0.001), independent of QRS duration (QRSd) and morphology (P<0.001). A QRS area reduction ≥45 μVs after CRT predicted cardiac mortality (HR: 0.19), total mortality (HR: 0.50), total mortality or heart failure hospitalization (HR: 0.44), total mortality or major adverse cardiac events (HR: 0.43) (all P<0.001) and the arrhythmic end point (HR: 0.26; P<0.001). A concomitant reduction in QRS area and QRSd was associated with the lowest risk of cardiac mortality and the arrhythmic end point (both HR: 0.12, P<0.001).ConclusionsPre‐implantation QRS area, derived from vectorcardiography, was superior to QRSd and QRS morphology in predicting cardiac mortality after CRT. A postimplant reduction in both QRS area and QRSd was associated with the best outcomes, including the arrhythmic end point.

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Aims  The COVID-19 pandemic has led to a decline in hospitalizations for non-COVID-19-related conditions. We explored the impact of the COVID-19 pandemic on cardiac operations and interventions undertaken in England. Methods and results  An administrative database covering hospital activity for England, the Health Episodes Statistics, was used to assess a total of 286 697 hospitalizations for cardiac operations and interventions, as well as 227 257 hospitalizations for myocardial infarction (MI) and 453 799 for heart failure (HF) from 7 January 2019 to 26 July 2020. Over the 3 months of ‘lockdown’, total numbers and mean reductions in weekly rates [n (−%)], compared with the same time period in 2019, were: coronary artery bypass grafting [−2507 (−64%)]; percutaneous coronary intervention [−5245 (−28%)]; surgical [−1324 (−41%)] and transcatheter [−284 (−21%)] aortic valve replacement; mitral valve replacement; implantation of pacemakers [−6450 (−44%)], cardiac resynchronization therapy with [−356 (−42%)] or without [−491 (−46%)] defibrillation devices, and implantable cardioverter-defibrillators [−501 (−45%)]; atrial fibrillation ablation [−1902 (−83%)], and other ablations [−1712 (−64%)] (all P &lt; 0.001). Over this period, there were 21 038 fewer procedures than in the reference period in 2019 (P &lt; 0.001). These changes paralleled reductions in hospitalizations for MI [−10 794 (−27%)] and HF [−63 058 (−28%)] (both P &lt; 0.001). Conclusions  The COVID-19 pandemic has led to substantial reductions in the number of cardiac operations and interventions undertaken. An alternative strategy for healthcare delivery to patients with cardiac conditions during the COVID-19 pandemic is urgently needed.