Implantable Cardioverter-Defibrillators With Versus Without Resynchronization Therapy in Patients With a QRS Duration >180 ms

Varun Sundaram, Jayakumar Sahadevan, Albert L. Waldo, George J. Stukenborg, Yogesh N.V. Reddy, Samuel J. Asirvatham, Judith A. Mackall, Anselma Intini, Brigid Wilson, Daniel I. Simon, Kenneth C. Bilchick

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background More than 20% of Medicare beneficiaries receiving cardiac resynchronization therapy defibrillators (CRT-D) have a very wide (≥180 ms) QRS complex duration (QRSD). Outcomes of CRT-D in these patients are not well-established because they have been underrepresented in clinical trials. Objectives This study examined outcomes in patients with CRT-D in a very wide QRSD with left bundle branch block (LBBB) versus those without LBBB. Methods Medicare patients from the Implantable Cardioverter Defibrillator Registry (January 1, 2005, through April 30, 2006) with a CRT-D and confirmed Class I or IIa indications for CRT-D were matched to implantable cardioverter-defibrillator (ICD) patients without CRT despite having Class I or IIa indications for CRT. Mortality and heart failure hospitalizations longer than 4 years with CRT-D versus standard ICDs based on a QRSD and morphology were analyzed. Results We analyzed 24,960 patients. Among those with LBBB, patients with a QRSD ≥180 ms had a greater adjusted survival benefit with CRT-D versus standard ICD (hazard ration [HR] for death: 0.65; 95% confidence interval [CI]: 0.59 to 0.72) compared with those having a QRSD 120 to 149 ms (HR: 0.85; 95% CI: 0.80 to 0.92) and 150 to 179 ms (HR: 0.87; 95% CI: 0.81 to 0.93). CRT-D versus ICD was associated with an improvement in survival in those with LBBB and a QRSD ≥180 ms (adjusted HR for death: 0.78; 95% CI: 0.68 to 0.91), but not in those with LBBB and a QRSD 150 to 179 ms (adjusted HR for death: 1.06; 95% CI: 0.95 to 1.19). Conclusions Improvements in both survival and heart failure hospitalizations with CRT-D were greatest in patients with a QRSD ≥180 ms with or without LBBB, whereas patients with a QRSD 150 to 179 ms without LBBB had no improvement in survival with CRT-D, and those with a QRSD 150 to 179 ms and LBBB had only a modest improvement.

Original languageEnglish (US)
Pages (from-to)2026-2036
Number of pages11
JournalJournal of the American College of Cardiology
Volume69
Issue number16
DOIs
StatePublished - Apr 25 2017

Keywords

  • bundle branch block
  • cardiac resynchronization therapy
  • heart failure
  • outcomes
  • very wide QRS complex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Sundaram, V., Sahadevan, J., Waldo, A. L., Stukenborg, G. J., Reddy, Y. N. V., Asirvatham, S. J., Mackall, J. A., Intini, A., Wilson, B., Simon, D. I., & Bilchick, K. C. (2017). Implantable Cardioverter-Defibrillators With Versus Without Resynchronization Therapy in Patients With a QRS Duration >180 ms. Journal of the American College of Cardiology, 69(16), 2026-2036. https://doi.org/10.1016/j.jacc.2017.02.042