Abstract
Aims. In the guidelines for cardiac resynchronization therapy (CRT), there is a gap between the Japanese Circulation Society (JCS) criteria, which specify a QRS duration of ≥120 ms, and other countries, with a QRS ≥ 130 ms. The efficacy of CRT remains controversial in patients with a narrow QRS <130 ms. The aims of this study are to evaluate the response to CRT in patients with a narrow QRS and to identify predictors of mortality. Methods. We retrospectively studied 212 patients who received CRT. They were divided into narrow QRS (<130 ms) and wide QRS (≥130 ms) groups. We compared CRT response rates and investigated whether age, gender, baseline New York Heart Association (NYHA) class, ischemic etiology, atrial fibrillation, and ventricular arrhythmias are associated with response and also predictive of mortality. Results. The CRT response rate was not significantly different between the wide QRS group and the narrow QRS group (74.6% versus 77.2%, p = 0.6876), and the response rate in the narrow QRS group was as good as that reported worldwide. NYHA class IV was shown to be a predictor of mortality (HR 9.38, 95% CI 5.35–16.3, p < 0.0001). Conclusions. The present study demonstrated that patients with a narrow QRS complex responded well to CRT. Even with QRS <130 ms, CRT should be tried if no other effective treatment is available.
Highlights
Despite the fact that cardiac resynchronization therapy (CRT) has been shown to be an effective treatment for heart failure (HF) [1,2,3,4], it is clearly underutilized in Japan
Differences in the guidelines between Japan and other countries, especially the European Society of Cardiology (ESC) guidelines [11], primarily account for this underutilization. e Japanese Circulation Society (JCS) guidelines recommend CRT for patients whose QRS is ≥120 ms [12], whereas the ESC guidelines classified patients with a narrow QRS complex of
We compared CRT response rates between the two groups and performed a multivariable analysis to determine whether QRS duration, LBBB morphology, baseline New York Heart Association (NYHA) functional class IV, ischemic etiology, atrial fibrillation (AF), gender, ventricular arrhythmias, and device type (CRT-P) are predictive of mortality. is study was approved by our institutional ethics committee
Summary
Despite the fact that cardiac resynchronization therapy (CRT) has been shown to be an effective treatment for heart failure (HF) [1,2,3,4], it is clearly underutilized in Japan. Differences in the guidelines between Japan and other countries, especially the European Society of Cardiology (ESC) guidelines [11], primarily account for this underutilization. E Japanese Circulation Society (JCS) guidelines recommend CRT for patients whose QRS is ≥120 ms [12], whereas the ESC guidelines classified patients with a narrow QRS complex of
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