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Cardiac resynchronization therapy benefit holds up in clinical practice

8 Jun, 14 | by Alistair Lindsay

The benefit of cardiac resynchronization therapy with a defibrillator (CRT-D) relative to implantable cardioverter-defibrillator (ICD) therapy alone has not been evaluated in routine clinical practice.  This study used data from the National Cardiovascular Data Registry’s ICD Registry linked with Medicare claims data to compare outcomes after CRT-D and ICD implantation in community practice.  The analysis included 7090 propensity matched patients who underwent either CRT-D or ICD implantation between 2006 and 2009 at one of 780 U.S. hospitals participating in the NCDR ICD registry.  Patients were over age 65 and met criteria for CRT-D implantation (left ventricular ejection fraction ≤ 35% and QRS duration ≥ 120ms). Over 3 years of follow-up, CRT-D was associated with lower risk of mortality (HR 0.82, 99% CI 0.73-0.93), all-cause readmission (HR 0.86, 99% CI 0.81-0.93), and heart failure readmission (HR 0.78, 99% CI 0.69-0.88) compared with ICD therapy.  However, CRT-D was also associated with a higher risk of device related infection (HR 1.90, 99% CI 1.07–3.37).  In subgroup analyses, the reduced risk of heart failure readmission was most prominent among patients with left bundle branch block or QRS duration of at least 150 ms. more…

No Benefit from Cardiac Resynchronization Therapy in Patients with a Narrow QRS Complex

28 Nov, 13 | by Alistair Lindsay

Cardiac-resynchronization therapy (CRT) has known benefits in patients with severe left ventricular systolic dysfunction and prolonged QRS duration (>120 ms).  However, up to half of patients with systolic dysfunction appear to have left ventricular dyssynchrony by echocardiographic measures, despite a QRS duration of less than 120 ms.  As a result, CRT is often used for patients with echocardiographic evidence of dyssynchrony and a narrow QRS complex, despite a lack of clear benefit to this approach.  The Echocardiography Guided Cardiac Resynchronization Therapy (EchoCRT) study sought to determine the effect of CRT on patient outcomes in the setting of symptomatic heart failure, echocardiographic findings of dyssynchrony, and QRS duration <120 ms. more…

Biventricular pacing for bradycardia

15 Jul, 13 | by Alistair Lindsay

Right ventricular (RV) pacing is used in patients presenting with high degree atrioventricular block, both to relieve symptoms related to bradycardia and improve prognosis. The majority of these patients are elderly and many of them will have a degree of co-existing left ventricular dysfunction which may be exacerbated by the electrical and mechanical dyssynchrony that occurs with RV pacing. The large cardiac-resynchronization (CRT) pacing studies performed to date have systematically excluded patients with indications for standard bradycardia pacing devices so as to concentrate solely on the benefits derived from cardiac resynchronisation, and consequently there is a paucity of data regarding this group. more…

Infective endocarditis caused by cardiac devices

5 May, 12 | by Alistair Lindsay

The number of electronic cardiac devices, including pacemakers and cardioverter-defibrillators, being implanted each year is increasing.  As a result, there has been a 210% increase in the incidence of device infection between 1993 and 2008 in the United States.  Cardiac device infective endocarditis (CDIE) is significant in that it is associated with a higher mortality rate than device infection without endocarditis. more…

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