Cardiac Resynchronization Aids Less Symptomatic Patients

Reduces heart failure morbidity and mortality, regardless of symptom severity

WEDNESDAY, Feb. 16 (HealthDay News) -- Cardiac resynchronization therapy (CRT), which reduces morbidity and mortality in patients with advanced heart failure, also reduces mortality and frequency of heart failure-related hospitalizations in patients with milder heart failure, according to a review published online Feb. 15 in the Annals of Internal Medicine.

Nawaf S. Al-Majed, M.B.B.S., of the University of Alberta in Edmonton, Canada, and colleagues conducted a systematic review of 25 randomized controlled trials of CRT. They investigated the impact of CRT in less symptomatic patients (New York Heart Association [NYHA] class I or II) compared to patients with advanced heart failure.

The researchers found that CRT reduced all-cause mortality and heart failure hospitalizations (relative risks, 0.83 and 0.71, respectively) in NYHA class I and II patients, but without improvements in functional outcomes or quality of life. In NYHA III and IV patients, CRT also reduced mortality and hospitalizations (relative risks, 0.78 and 0.65, respectively), and it improved functional outcomes. The implant success rate was 94.4 percent. The researchers noted a 0.3 percent peri-implant death rate, a 3.2 percent mechanical complication rate, a 6.2 percent lead problem rate, and a 1.4 percent infection rate.

"Our data support the expansion of indications for CRT to incorporate less symptomatic patients with heart failure who have left ventricular ejection fraction <30 percent, QRS duration >120 msec, and are in sinus rhythm," the authors write.

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