title: A randomized study of cardiac resynchronization therapy defibrillator versus dual-chamber implantable cardioverter-defibrillator in ischemic cardiomyopathy with narrow QRS: the NARROW-CRT study.
abstract: BACKGROUND
  Current recommendations require a QRS duration of ≥120 ms as a condition for prescribing cardiac resynchronization therapy (CRT). This study was designed to test the hypothesis that patients with heart failure (HF) of ischemic origin, current indications for defibrillator implantation, and QRS <120 ms may benefit from CRT in the presence of marked mechanical dyssynchrony.
  
  
  RESULTS
  Patients with intraventricular dyssynchrony on echocardiography were randomly assigned to CRT or dual-chamber defibrillator implantation (CRT defibrillator and dual-chamber implantable cardioverter-defibrillator arm, respectively). The primary end point was the HF clinical composite response, which scores patients as improved, unchanged, or worsened. The secondary end point was the cumulative survival from HF hospitalization and HF death. An additional secondary end point was the composite of HF hospitalization, HF death, and spontaneous ventricular fibrillation. Twenty-three of 56 patients with CRT defibrillator showed an improvement in their clinical composite response at 1 year, compared with 9 of 55 patients with dual-chamber implantable cardioverter-defibrillator (41% versus 16%; P=0.004). After a median follow-up of 16 months, the CRT defibrillator arm showed a nonsignificant higher survival from HF hospitalization and HF death (P=0.077), and a significantly higher survival from the combined end point of HF hospitalization, HF death, and spontaneous ventricular fibrillation (P=0.028).
  
  
  CONCLUSIONS
  In this comparison of CRT defibrillator and dual-chamber implantable cardioverter-defibrillator, CRT improved clinical status in some patients with ischemic cardiomyopathy, mild-to-moderate symptoms, narrow QRS duration, and mechanical dyssynchrony on echocardiography.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique identifier: NCT01577446.
authors.affiliation: Ospedale S.Maria di Loreto Mare, Napoli, Italy. carminemuto@libero.it
authors.forename: Carmine
authors.initials: C
authors.lastname: Muto
authors.forename: Francesco
authors.initials: F
authors.lastname: Solimene
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Nastasi
authors.forename: Concetto
authors.initials: C
authors.lastname: La Rosa
authors.forename: Raimondo
authors.initials: R
authors.lastname: Calvanese
authors.forename: Raffaele
authors.initials: R
authors.lastname: Iengo
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Canciello
authors.forename: Raffaele
authors.initials: R
authors.lastname: Sangiuolo
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.forename: Carmine
authors.initials: C
authors.lastname: Ciardiello
authors.forename: Bernardino
authors.initials: B
authors.lastname: Tuccillo
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods*; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017147:Defibrillators, Implantable; D015150:Echocardiography, Doppler; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy
keywords: CRT; dyssynchrony; heart failure; narrow QRS