QRS morphology as a predictor of the response to cardiac resynchronisation therapy: fact or fashion?

Cleland, John G.F.; Freemantle, Nick

doi:10.1136/heartjnl-2015-307553

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…[6][7][8][9] Observational studies suggest that patients with RBBB have a worse outcome, but this may reflect their higher prevalence of IHD rather than less response to CRT. 23 Moreover, many patients with RBBB have concealed LBBB, blurring the distinction between groups. 5,24,25 However, the paucity of data for patients with a QRS morphology other than LBBB creates uncertainty and provides some justification for a lower strength of guideline recommendations for patients who do not have LBBB.…”

Section: Discussionmentioning

confidence: 99%

“…None of the landmark trials used QRS morphology as an inclusion criterion, but guidelines both on the prevention of sudden death and on heart failure give stronger recommendations for patients who have LBBB, despite the lack of evidence from pre‐specified subgroup analyses 6–9 . Observational studies suggest that patients with RBBB have a worse outcome, but this may reflect their higher prevalence of IHD rather than less response to CRT 23 . Moreover, many patients with RBBB have concealed LBBB, blurring the distinction between groups 5,24,25 .…”

Section: Discussionmentioning

confidence: 99%

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The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF

Cleland

Bristow²,

Freemantle

et al. 2022

European J of Heart Fail

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Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT-P) on all-cause mortality or the composite of hospitalization for heart failure or all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF

Cleland

Bristow²,

Freemantle

et al. 2022

European J of Heart Fail

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Cardiac Resynchronization Therapy Update: Evolving Indications, Expanding Benefit?

et al. 2015

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Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.

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Cardiac resynchronization therapy and its role in the management of heart failure

et al. 2017

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The prevalence of heart failure is increasing and it is associated with significant mortality and morbidity. Optimal medical therapy improves outcome, but heart failure continues to have a substantial impact on both the individual patient and wider society. Over the last two decades, cardiac resynchronization therapy has revolutionized the treatment of selected patients who have heart failure. Cardiac resynchronization therapy significantly reduces mortality and hospitalization through reverse cardiac remodelling. This review informs non-specialists about cardiac resynchronization therapy and for which patients it should be considered.

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QRS morphology as a predictor of the response to cardiac resynchronisation therapy: fact or fashion?

Cited by 3 publications

References 27 publications

The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF

The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF

Cardiac Resynchronization Therapy Update: Evolving Indications, Expanding Benefit?

Cardiac resynchronization therapy and its role in the management of heart failure

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