Good Outcome With Cardiac Resynchronization Therapy for Heart Failure

NEW YORK (Reuters Health) Feb 07 - Patients with advanced heart failure and ventricular function delay (QRS duration of 120 ms or greater) who are treated with cardiac resynchronization therapy have a favorable long-term outcome.
"It is unknown whether the magnitude of survival benefits conferred by cardiac resynchronization therapy in a daily practice scenario is comparable to what has been observed in randomized controlled trials and whether this benefit is sustained over the long term," Dr. Angelo Auricchio, of University Hospital, Magdeburg, Germany, and colleagues write.

To investigate, the researchers examined the long-term outcome of 1303 consecutive heart failure patients with prolonged QRS duration treated with cardiac resynchronization therapy alone (44%) or with implantable cardioverter-defibrillator backup.
The researchers evaluated the cumulative event-free survival using a combined end point of death from any cause, urgent heart transplantation, or implantation of a left ventricular assist device. The team also assessed the cumulative incidence of competing events, including heart failure, sudden cardiac death and non-cardiac death. The results are published in the January 15th issue of the American Journal of Cardiology.

At 1- and 5-year follow-up, the cumulative event-free survival was 92% and 56%, respectively. The cumulative incidence of heart failure, sudden cardiac death and death from other causes was 25.1%, 9.5% and 8.8%.
Results of multivariable analysis revealed an association between treatment with a combined device and a nonsignificant 20% lower mortality.

"Patients treated with a combined device had a significantly lower incidence of sudden cardiac death than patients treated with CRT alone (HR 0.04, p < 0.002)," Dr. Auricchio's team writes. "Only two sudden deaths occurred in the 726 patients treated with a combined device...compared with 34 of 572 patients...treated with a resynchronization device alone."
Source: Reuters-Am J Cardiol 2007;99:232-238.


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