Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure
Abstract
BACKGROUND: Cardiac-resynchronization therapy (CRT) benefits patients with left ventricular systolic dysfunction and a wide QRS complex. Most of these patients are candidates for an implantable cardioverter-defibrillator (ICD). We evaluated whether adding CRT to an ICD and optimal medical therapy might reduce mortality and morbidity among such patients. METHODS: We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more or a paced QRS duration of 200 msec or more to receive either an ICD alone or an ICD plus CRT. The primary outcome was death from any cause or hospitalization for heart failure. RESULTS: We followed 1798 patients for a mean of 40 months. The primary outcome occurred in 297 of 894 patients (33.2%) in the ICD-CRT group and 364 of 904 patients (40.3%) in the ICD group (hazard ratio in the ICD-CRT group, 0.75; 95% confidence interval [CI], 0.64 to 0.87; P<0.001). In the ICD-CRT group, 186 patients died, as compared with 236 in the ICD group (hazard ratio, 0.75; 95% CI, 0.62 to 0.91; P = 0.003), and 174 patients were hospitalized for heart failure, as compared with 236 in the ICD group (hazard ratio, 0.68; 95% CI, 0.56 to 0.83; P<0.001). However, at 30 days after device implantation, adverse events had occurred in 124 patients in the ICD-CRT group, as compared with 58 in the ICD group (P<0.001). CONCLUSIONS: Among patients with NYHA class II or III heart failure, a wide QRS complex, and left ventricular systolic dysfunction, the addition of CRT to an ICD reduced rates of death and hospitalization for heart failure. This improvement was accompanied by more adverse events. (Funded by the Canadian Institutes of Health Research and Medtronic of Canada; ClinicalTrials.gov number, NCT00251251.).
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Patients with T2DM did not experience a higher rate of complications related to device implantation, including infection.
“Patients with T2DM did not experience a higher rate of complications related to device implantation, including infection.170”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [170]
Subgroup analysis of the RAFT trial showed that the benefit of CRT-D was similar in patients with and without T2DM.
“Also, subgroup analysis of the RAFT trial showed that the benefit of CRT-D was similar in patients with and without T2DM.170”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [170]
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Self-citationImpact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy
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Self-citationIndividual patient data network meta-analysis of mortality effects of implantable cardiac devices
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- Authors
- Tang, A. S. L., Wells, G. A., Talajic, M., Arnold, M. O., Sheldon, R., Connolly, S., Hohnloser, S. H., Nichol, G., Birnie, D. H., Sapp, J. L., Yee, R., Healey, J. S., & Rouleau, J. L.
- Affiliations
- University of British Columbia (CA)
- Ottawa Heart Institute (CA)
- Montreal Heart Institute (CA)
- London Health Sciences Centre (CA)
- University of Calgary (CA)
- Hamilton Health Sciences (CA)
- Goethe University Frankfurt (DE)
- University of Washington (US)
- Queen Elizabeth II Health Sciences Centre (CA)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-12-16
- Volume
- 363
- Issue
- 25
- Pages
- 2385-2395
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2141895646
- Cited by
- 1,859
- References
- 28
- Citations by year
- 2026: 55 · 2025: 67 · 2024: 73 · 2023: 109 · 2022: 76 · 2021: 88 · 2020: 107 · 2019: 99 · 2018: 100 · 2017: 121 · 2016: 141 · 2015: 154 · 2014: 149 · 2013: 190 · 2012: 176
- FWCI
- 113.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- cardiac resynchronization therapy, implantable cardioverter-defibrillator, heart failure, wide QRS complex, left ventricular systolic dysfunction, mortality, heart failure hospitalization, device implantation complications, optimal medical therapy, left ventricular ejection fraction
- MeSH terms
- Aged, Cardiac Pacing, Artificial, Double-Blind Method, Electrocardiography, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Severity of Illness Index, Defibrillators, Implantable, Ventricular Dysfunction, Left, Kaplan-Meier Estimate, Intention to Treat Analysis
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