PMID- 19717348
OWN - NLM
STAT- MEDLINE
DCOM- 20100318
LR  - 20220331
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 6
IP  - 10
DP  - 2009 Oct
TI  - Upgrade and de novo cardiac resynchronization therapy: impact of paced or 
      intrinsic QRS morphology on outcomes and survival.
PG  - 1439-47
LID - 10.1016/j.hrthm.2009.07.009 [doi]
AB  - BACKGROUND: Cardiac resynchronization therapy (CRT) improves outcomes in patients 
      with left bundle branch block (LBBB), but the benefits of CRT in patients with 
      other QRS morphologies or previous pacing are uncertain. OBJECTIVE: The purpose 
      of this study was to describe outcomes in patients with prior right ventricular 
      pacing and non-LBBB morphologies. METHODS: We studied 505 patients who underwent 
      de novo CRT (n = 338) or CRT upgrade (n = 167). De novo patients were categorized 
      by underlying QRS morphology: LBBB (67%), right bundle branch block (RBBB; 11%), 
      intraventricular conduction delay (IVCD; 13%), and QRS <120 ms (9%). Upgrade 
      patients were categorized by the percentage of previous ventricular pacing. 
      RESULTS: Patients were followed for death over a median of 2.6 years 
      (interquartile range 1.6-4.0). New York Heart Association (NYHA) functional class 
      and echocardiographic improvements were similar in de novo and upgrade patients. 
      However, within the de novo group, NYHA improvements were less in patients with 
      RBBB (0.3 +/- 0.8; P = .014) or IVCD (0.2 +/- 0.7; P = .001) than in those with 
      LBBB (0.7 +/- 0.8). These patients had less left ventricular functional 
      improvement as well. Survival was comparable after de novo versus upgrade CRT 
      (61% vs 63% at 4 years; P = .906). No clinical or survival differences were noted 
      in upgrade patients based on the percentage of previous pacing. However, survival 
      in de novo CRT recipients with RBBB (32%) was lower than in those with LBBB (66%; 
      P <.001), and RBBB independently predicted death (hazard ratio 3.5, confidence 
      interval 1.9-6.5; P <.001). CONCLUSION: RBBB and IVCD result in less clinical 
      improvement or worsened survival after CRT. Additional selection criteria may be 
      beneficial in identifying potential responders with RBBB, IVCD, or narrow QRS.
FAU - Wokhlu, Anita
AU  - Wokhlu A
AD  - Mayo Clinic, Rochester, MN 55905, USA.
FAU - Rea, Robert F
AU  - Rea RF
FAU - Asirvatham, Samuel J
AU  - Asirvatham SJ
FAU - Webster, Tracy
AU  - Webster T
FAU - Brooke, Kelly
AU  - Brooke K
FAU - Hodge, David O
AU  - Hodge DO
FAU - Wiste, Heather J
AU  - Wiste HJ
FAU - Dong, Yingxue
AU  - Dong Y
FAU - Hayes, David L
AU  - Hayes DL
FAU - Cha, Yong-Mei
AU  - Cha YM
LA  - eng
PT  - Journal Article
DEP - 20090710
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
CIN - Heart Rhythm. 2009 Oct;6(10):1448-9. PMID: 19968923
MH  - Aged
MH  - Arrhythmias, Cardiac/mortality/*physiopathology
MH  - Bundle-Branch Block/mortality/therapy
MH  - *Cardiac Pacing, Artificial
MH  - *Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Conduction System
MH  - Heart Failure/physiopathology
MH  - Humans
MH  - Male
MH  - Prognosis
MH  - Treatment Outcome
EDAT- 2009/09/01 06:00
MHDA- 2010/03/20 06:00
CRDT- 2009/09/01 09:00
PHST- 2009/03/29 00:00 [received]
PHST- 2009/07/06 00:00 [accepted]
PHST- 2009/09/01 09:00 [entrez]
PHST- 2009/09/01 06:00 [pubmed]
PHST- 2010/03/20 06:00 [medline]
AID - S1547-5271(09)00748-6 [pii]
AID - 10.1016/j.hrthm.2009.07.009 [doi]
PST - ppublish
SO  - Heart Rhythm. 2009 Oct;6(10):1439-47. doi: 10.1016/j.hrthm.2009.07.009. Epub 2009 
      Jul 10.