Colin Cunnington1, Chun Shing Kwok2, Duwarakan K Satchithananda3, Ashish Patwala3, Muhammad A Khan1, Amir Zaidi1, Fozia Z Ahmed4, Mamas A Mamas5. 1. Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK. 2. Cardiovascular Institute, University of Manchester, Manchester, UK. 3. Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, UK. 4. Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK Cardiovascular Institute, University of Manchester, Manchester, UK. 5. Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK Cardiovascular Institute, University of Manchester, Manchester, UK Farr Institute, University of Manchester, Manchester, UK.
Abstract
OBJECTIVES: Recently published clinical guidelines recommend cardiac resynchronisation therapy (CRT) for patients with heart failure (HF) with reduced LVEF and non-left bundle branch block (non-LBBB) QRS morphology. We sought to define the potential benefit of CRT in these patients through meta-analysis of randomised controlled trials (RCTs) that have reported outcomes in patients with non-LBBB QRS morphology. METHODS: We searched MEDLINE and EMBASE for RCTs of CRT that reported outcomes according to QRS morphology. We performed meta-analysis of these RCTs to assess the effect of CRT on the end points of death, HF hospitalisation, and the composite of death and HF hospitalisation. RESULTS: Five RCTs were analysed, including 6523 participants (1766 with non-LBBB QRS morphology). CRT was not associated with a reduction in death and/or HF hospitalisation in subjects with non-LBBB QRS morphology (HR 0.99 95% CI 0.82 to 1.20). CONCLUSIONS: CRT is not associated with a reduction in death or HF hospitalisation in patients with non-LBBB QRS morphology. Wide QRS with non-LBBB morphology remains an area of uncertainty for CRT, which is included in the recent European Society of Cardiology guidelines with a weaker strength of recommendation, but is not supported by a dedicated RCT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: Recently published clinical guidelines recommend cardiac resynchronisation therapy (CRT) for patients with heart failure (HF) with reduced LVEF and non-left bundle branch block (non-LBBB) QRS morphology. We sought to define the potential benefit of CRT in these patients through meta-analysis of randomised controlled trials (RCTs) that have reported outcomes in patients with non-LBBB QRS morphology. METHODS: We searched MEDLINE and EMBASE for RCTs of CRT that reported outcomes according to QRS morphology. We performed meta-analysis of these RCTs to assess the effect of CRT on the end points of death, HF hospitalisation, and the composite of death and HF hospitalisation. RESULTS: Five RCTs were analysed, including 6523 participants (1766 with non-LBBB QRS morphology). CRT was not associated with a reduction in death and/or HF hospitalisation in subjects with non-LBBB QRS morphology (HR 0.99 95% CI 0.82 to 1.20). CONCLUSIONS: CRT is not associated with a reduction in death or HF hospitalisation in patients with non-LBBB QRS morphology. Wide QRS with non-LBBB morphology remains an area of uncertainty for CRT, which is included in the recent European Society of Cardiology guidelines with a weaker strength of recommendation, but is not supported by a dedicated RCT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Herbert B Tanowitz; Fabiana S Machado; David C Spray; Joel M Friedman; Oren S Weiss; Jose N Lora; Jyothi Nagajyothi; Diego N Moraes; Nisha Jain Garg; Maria Carmo P Nunes; Antonio Luiz P Ribeiro Journal: Expert Rev Cardiovasc Ther Date: 2015-10-23
Authors: Arwa Younis; Mehmet K Aktas; Wojciech Zareba; Scott McNitt; Valentina Kutyifa; Ilan Goldenberg Journal: Ann Noninvasive Electrocardiol Date: 2021-03-27 Impact factor: 1.468
Authors: Brian R Lindman; Suzanne V Arnold; Rodrigo Bagur; Lindsay Clarke; Megan Coylewright; Frank Evans; Judy Hung; Sandra B Lauck; Susan Peschin; Vandana Sachdev; Lisa M Tate; Jason H Wasfy; Catherine M Otto Journal: J Am Heart Assoc Date: 2020-04-24 Impact factor: 5.501