title: Reduced long-term overall mortality in heart failure patients with prolonged QRS treated with CRT combined with ICD vs. heart failure patients with narrow QRS treated with ICD only.
abstract: OBJECTIVE
  It is not known whether heart failure (HF) patients with prolonged QRS who undergo cardiac resynchronization therapy combined with a defibrillator (CRT-D) have a prognostic advantage over HF patients with narrow QRS (therefore without indication for CRT) treated with an implantable cardioverter defibrillator (ICD) only. The aim of this study was to compare the long-term mortality of a group of HF patients with prolonged QRS receiving CRT-D with that of a similar group of patients with narrow QRS receiving ICD only.
  
  
  RESULTS
  A total of 312 patients (mean age 66 ± 13 years; 84% male, mean left ventricular ejection fraction 25 ± 4%, mean New York Heart Association class 2.6 ± 0.5) were included in the analysis. Of these, 138 with a QRS complex duration ≥120 ms received a CRT-D. During follow-up, the time and cause of death were assessed. During a median follow-up of 46 months, CRT-D patients showed significantly lower overall mortality (P = 0.038). Compared with patients receiving ICD only, CRT-D patients showed lower HF mortality (P = 0.003). Coronary mortality, non-cardiac mortality, and sudden mortality were similar in both groups (all P > 0.05). A positive response to CRT was an independent predictor of reduced mortality on multivariate analysis (hazard ratio: 0.27; P = 0.047).
  
  
  CONCLUSIONS
  In HF patients treated with ICD, the subgroup of patients with prolonged QRS who receive CRT-D displays better long-term survival than narrow QRS ICD recipients, owing to their reduced HF mortality.
authors.affiliation: Cardiology Unit, 'Card. G. Panico' Hospital, Via S. Pio X, 4, 73039 Tricase (Le), Italy dr.palmisano@libero.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Palmisano
authors.affiliation: Cardiology Unit, 'Card. G. Panico' Hospital, Via S. Pio X, 4, 73039 Tricase (Le), Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Accogli
authors.affiliation: Vito Fazzi Hospital, Lecce, Italy.
authors.forename: Ennio Carmine Luigi
authors.initials: EC
authors.lastname: Pisanò
authors.affiliation: Cardiology Unit, 'Card. G. Panico' Hospital, Via S. Pio X, 4, 73039 Tricase (Le), Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Zaccaria
authors.affiliation: Cardiology Unit, 'Card. G. Panico' Hospital, Via S. Pio X, 4, 73039 Tricase (Le), Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: De Blasi
authors.affiliation: Cardiology Unit, 'Card. G. Panico' Hospital, Via S. Pio X, 4, 73039 Tricase (Le), Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Ponzetta
authors.affiliation: Boston Scientific Italia S.p.A., Milano, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.affiliation: Vito Fazzi Hospital, Lecce, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Milanese
authors.affiliation: Vito Fazzi Hospital, Lecce, Italy.
authors.forename: Maurelio
authors.initials: M
authors.lastname: Lauretti
authors.affiliation: Vito Fazzi Hospital, Lecce, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Magliari
mesh_terms: D000200:Action Potentials; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D002423:Cause of Death; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D065840:Protective Factors; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy with defibrillator; Causes of death; Heart failure; Implantable cardioverter defibrillator; Sudden cardiac death