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J Am Coll Cardiol, 2006; 48:2243-2250, doi:10.1016/j.jacc.2006.07.067 (Published online 8 November 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE TREATMENT

Cardiac Resynchronization Therapy in Patients With a Narrow QRS Complex

Gabe B. Bleeker, MD*,{dagger}, Eduard R. Holman, MD, PhD*, Paul Steendijk, PhD*, Eric Boersma, PhD{ddagger}, Ernst E. van der Wall, MD, PhD*, Martin J. Schalij, MD, PhD* and Jeroen J. Bax, MD, PhD*,*

* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlandss
{dagger} Interuniversity Cardiology Institute Netherlands (ICIN), Utrecht, the Netherlands
{ddagger} Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands.

Manuscript received April 6, 2006; revised manuscript received July 14, 2006, accepted July 27, 2006.

* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).

OBJECTIVES: The purpose of this study was to evaluate the effects of cardiac resynchronization therapy (CRT) in heart failure patients with narrow QRS complex (<120 ms) and evidence of left ventricular (LV) dyssynchrony on tissue Doppler imaging (TDI).

BACKGROUND: Cardiac resynchronization therapy is beneficial in selected heart failure patients with wide QRS complex (≥120 ms). Patients with narrow QRS complex are currently not eligible for CRT, and the potential effects of CRT are not well studied.

METHODS: Thirty-three consecutive patients with narrow QRS complex and 33 consecutive patients with wide QRS complex (control group) were prospectively included. All patients needed to have LV dyssynchrony ≥65 ms on TDI, New York Heart Association (NYHA) functional class III/IV heart failure, and LV ejection fraction ≤35%.

RESULTS: Baseline characteristics, particularly LV dyssynchrony, were comparable between patients with narrow and wide QRS complex (110 ± 8 ms vs. 175 ± 22 ms; p = NS). No significant relationship was observed between baseline QRS duration and LV dyssynchrony (r = 0.21; p = NS). The improvement in clinical symptoms and LV reverse remodeling was comparable between patients with narrow and wide QRS complex (mean NYHA functional class reduction 0.9 ± 0.6 vs. 1.1 ± 0.6 [p = NS] and mean LV end-systolic volume reduction 39 ± 34 ml vs. 44 ± 46 ml [p = NS]).

CONCLUSIONS: Cardiac resynchronization therapy appears to be beneficial in patients with narrow QRS complex and severe LV dyssynchrony on TDI, with similar improvement in symptoms and comparable LV reverse remodeling to patients with wide QRS complex. The current results need confirmation in larger patient cohorts.

Abbreviations and Acronyms
  CRT = cardiac resynchronization therapy
  EF = ejection fraction
  LV = left ventricular
  NYHA = New York Heart Association
  TDI = tissue Doppler imaging




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