![]() ![]() No clinical or survival differences were noted in upgrade patients based on the percentage of previous pacing. Survival was comparable after de novo versus upgrade CRT (61% vs 63% at 4 years P =. These patients had less left ventricular functional improvement as well. However, within the de novo group, NYHA improvements were less in patients with RBBB (0.3 ± 0.8 P =. New York Heart Association (NYHA) functional class and echocardiographic improvements were similar in de novo and upgrade patients. Results: Patients were followed for death over a median of 2.6 years (interquartile range 1.6-4.0). Upgrade patients were categorized by the percentage of previous ventricular pacing. 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%). Methods: We studied 505 patients who underwent de novo CRT (n = 338) or CRT upgrade (n = 167). Objective: The purpose of this study was to describe outcomes in patients with prior right ventricular pacing and non-LBBB morphologies. Additional selection criteria may be beneficial in identifying potential responders with RBBB, IVCD, or narrow QRS.Ībstract = "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. Conclusion: RBBB and IVCD result in less clinical improvement or worsened survival after CRT. ![]() 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). European Journal of Heart Failure © 2014 European Society of Cardiology.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. The underutilization of CRT was worse with increasing age.Īge Cardiac resynchronization therapy Epidemiology Heart Failure Intraventricular conduction delay Left bundle branch block QRS width. 37%, respectively (P < 0.001).īoth IVCD and LBBB were more common with increasing age and were similarly strong independent predictors of mortality and in all ages. 4% and absent but with indication in 23% vs. In the three age groups, CRT was present in 6% vs. The adjusted P for interaction between age and QRS morphology was 0.664. Among 13 782 patients without CRT, IVCD was present in the three age groups in 11% vs. We studied 14 713 patients with ejection fraction ≤39% in the Swedish Heart Failure Registry and divided into age groups ≤65 years, 66-80 years and >80 years. We tested the hypotheses that in the elderly: (i) IVCD and LBBB are more prevalent, (ii) IVCD and LBBB are more harmful, and (iii) CRT is underutilized. Age is not a contraindication to cardiac resynchronization therapy (CRT), but the prevalence and prognostic impact of QRS prolongation with intraventricular conduction delay (IVCD) and left bundle branch block (LBBB), as well as CRT utilization, may differ with age.
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