PMID- 17565085
OWN - NLM
STAT- MEDLINE
DCOM- 20070618
LR  - 20220318
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 297
IP  - 22
DP  - 2007 Jun 13
TI  - Cardiac resynchronization therapy for patients with left ventricular systolic 
      dysfunction: a systematic review.
PG  - 2502-14
AB  - CONTEXT: Left ventricular (LV) systolic dysfunction causes substantial morbidity 
      and mortality, even with optimal pharmacotherapy. Atrial-synchronized 
      biventricular pacemakers (cardiac resynchronization therapy [CRT]) received US 
      Food and Drug Administration (FDA) approval for use in selected patients with LV 
      systolic dysfunction in 2001. OBJECTIVE: To summarize the current evidence base 
      for the efficacy, effectiveness, and safety of CRT in patients with LV systolic 
      dysfunction. EVIDENCE ACQUISITION: A search of multiple electronic databases 
      until November 2006 was supplemented by hand searches of reference lists of 
      included studies and review articles, proceedings booklets from meetings, FDA 
      reports, and contact with primary study authors and device manufacturers. A total 
      of 14 randomized trials (4420 patients) were included for the CRT efficacy 
      review, 106 studies (9209 patients) for the CRT effectiveness review, and 89 
      studies (9677 patients) reported safety outcomes with implantation of a CRT 
      device. EVIDENCE SYNTHESIS: All patients in the CRT studies had LV systolic 
      dysfunction (mean LV ejection fraction [LVEF] range, 21%-30%), prolonged QRS 
      duration (mean range, 155-209 milliseconds), and 91% had New York Heart 
      Association (NYHA) class 3 or 4 heart failure symptoms despite optimal 
      pharmacotherapy. CRT improved LVEF (weighted mean difference, 3.0%; 95% 
      confidence interval [CI], 0.9%-5.1%), quality of life (weighted mean reduction in 
      Minnesota Living With Heart Failure Questionnaire, 8.0 points; 95% CI, 5.6-10.4 
      points), and functional status (improvements of >/=1 NYHA class were observed in 
      59% of CRT recipients in the randomized trials). CRT decreased hospitalizations 
      by 37% (95% CI, 7%-57%), and all-cause mortality decreased by 22% (95% CI, 
      9%-33%). Implant success rate was 93.0% (95% CI, 92.2%-93.7%) and 0.3% of 
      patients died during implantation (95% CI, 0.1%-0.6%). During a median 11-month 
      follow-up, 6.6% (95% CI, 5.6%-7.4%) of CRT devices exhibited lead problems and 5% 
      (95% CI, 4%-7%) malfunctioned. CONCLUSIONS: CRT reduces morbidity and mortality 
      in patients with LV systolic dysfunction, prolonged QRS duration, and NYHA class 
      3 or 4 symptoms when combined with optimal pharmacotherapy. The incremental 
      benefits of combined CRT plus implantable cardioverter-defibrillator devices vs 
      CRT-alone devices in patients with LV systolic dysfunction remain uncertain.
FAU - McAlister, Finlay A
AU  - McAlister FA
AD  - The University of Alberta Evidence-based Practice Center, Edmonton, Alberta, 
      Canada. finlay.mcalister@ualberta.ca
FAU - Ezekowitz, Justin
AU  - Ezekowitz J
FAU - Hooton, Nicola
AU  - Hooton N
FAU - Vandermeer, Ben
AU  - Vandermeer B
FAU - Spooner, Carol
AU  - Spooner C
FAU - Dryden, Donna M
AU  - Dryden DM
FAU - Page, Richard L
AU  - Page RL
FAU - Hlatky, Mark A
AU  - Hlatky MA
FAU - Rowe, Brian H
AU  - Rowe BH
LA  - eng
GR  - 290-02-0023/PHS HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - IM
CIN - ACP J Club. 2007 Nov-Dec;147(3):58. PMID: 17975860
MH  - Defibrillators, Implantable
MH  - Humans
MH  - *Pacemaker, Artificial
MH  - Systole
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*therapy
RF  - 157
EDAT- 2007/06/15 09:00
MHDA- 2007/06/19 09:00
CRDT- 2007/06/15 09:00
PHST- 2007/06/15 09:00 [pubmed]
PHST- 2007/06/19 09:00 [medline]
PHST- 2007/06/15 09:00 [entrez]
AID - 297/22/2502 [pii]
AID - 10.1001/jama.297.22.2502 [doi]
PST - ppublish
SO  - JAMA. 2007 Jun 13;297(22):2502-14. doi: 10.1001/jama.297.22.2502.