CLINICAL RESEARCH
Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and "narrow" QRS
Augusto Achilli, MD*,*,
Massimo Sassara, MD*,
Sabina Ficili, MD*,
Daniele Pontillo, MD*,
Paola Achilli, MD*,
Claudio Alessi, MD*,
Stefano De Spirito, MD*,
Roberto Guerra, MD*,
Nicolino Patruno, MD and
Francesco Serra, MD*
* Cardiovascular Department, Belcolle Hospital, Viterbo, Italy
Cardiology Division, S.Giuseppe Hospital, Albano Laziale, Italy
Manuscript received August 20, 2002;
revised manuscript received August 13, 2003,
accepted August 19, 2003.
* Reprint requests and correspondence: Dr. Augusto Achilli, Cardiovascular Department, Belcolle Hospital, Via Monfalcone, 20/A, 01100 Viterbo, Italy.
aachilli{at}libero.it
OBJECTIVES: The aim of the study was to evaluate the effectiveness of cardiac resynchronization therapy (CRT) in patients with refractory heart failure (HF) and incomplete left bundle branch block ("narrow" QRS), together with echocardiographic evidence of interventricular and intraventricular asynchrony.
BACKGROUND: Cardiac resynchronization therapy has been proven effective in patients with HF and wide QRS by ameliorating contraction asynchrony.
METHODS: Fifty-two patients with severe HF received biventricular pacing. The patients were eligible in the presence of echocardiographic evidence of interventricular and intraventricular asynchrony, regardless of QRS duration. The patient population was divided into group 1 (n = 38), with a QRS duration >120 ms, and group 2 (n = 14), with a QRS duration  120 ms.
RESULTS: The baseline parameters considered in the study were similar in both groups. At follow-up, CRT determined narrowing of the QRS interval in the entire population and in group 1 (p < 0.001), whereas a small increase in QRS duration was observed in group 2 (p = NS); in all patients and within groups, we observed improvement of New York Heart Association functional class (p < 0.001 in all), left ventricular ejection fraction (p < 0.001 in all), left ventricular end-diastolic and end-systolic diameter (p < 0.05 within groups), mitral regurgitation area (p < 0.001 in all), interventricular delay (p < 0.001 in all), and deceleration time (group 1: p < 0.001, group 2: p < 0.05), with no significant difference between groups. The 6-min walking test improved in both groups (group 1: p < 0.001; group 2: p < 0.01).
CONCLUSIONS: Cardiac resynchronization therapy determined clinical and functional benefit that was similar in patients with wide or "narrow" QRS. Cardiac resynchronization therapy may be helpful in patients with echocardiographic evidence of interventricular and intraventricular asynchrony and incomplete left bundle branch block.
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Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | AV | = atrioventricular | | CRT | = cardiac resynchronization therapy | | DCM | = dilated cardiomyopathy | | DT | = deceleration time | | E-A | = left ventricular filling time | | ECG | = electrocardiogram | | EF | = ejection fraction | | HF | = heart failure | | IVD | = interventricular delay | | LBBB | = left bundle branch block | | LVEDD | = left ventricular end-diastolic diameter | | LVESD | = left ventricular end-systolic diameter | | MR | = mitral regurgitation | | NYHA | = New York Heart Association | | PM | = pacemaker | | SR | = sinus rhythm | | Q-E | = Q-wave–transmitral filling E-wave interval | | Q-LW | = posterolateral left ventricular wall activation delay | | 6MWT | = 6-min walking test |
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