In recent weeks the cardiac resynchronization therapy (CRT) field has been absorbing the publication of the BLOCK HF trial in the New England Journal of Medicine and the publication of the NARROW-CRT trial in Circulation: Arrhythmia and Electrophysiology. These trials raised the possibility that CRT may improve clinical status in some patients with ischemic cardiomyopathy…

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Two new trials have ended up reporting conflicting results regarding the expansion of the indication for cardiac resynchronization therapy (CRT) for patients without a wide QRS interval.  The positive results of the smaller trial seem likely to be undermined by the early stopping of the much larger trial. The first trial, NARROW-CRT, published in Circulation:…

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Patients with atrioventricular (AV) block generally receive right ventricular (RV) pacing; cardiac resynchronization therapy (CRT) has been restricted to patients with a low ejection fraction and a wide QRS duration. However, RV pacing may worsen LV dysfunction in AV block patients with low ejection fractions. Previous studies have raised the possibility that these patients may…

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The American College of Cardiology (ACC) and the Heart Rhythm Society (HRS) today published appropriate use criteria for implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT). The document offers an expert consensus on the appropriateness of  369 separate real-life clinical scenarios in six areas: ICDs for secondary prevention, ICDs for primary prevention, comorbidities, CRT devices, generator replacement,…

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A newly released update of 2008 guidelines for device-based therapy of cardiac arrhythmias contains some much-needed clarification about indications for cardiac resynchronization therapy (CRT). The document was developed jointly by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society. Highlights of the documents include: The Class 1 recommendation for CRT for…

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A large new study has found significant risks and costs associated with infections following the implantation of CIEDs (cardiovascular implantable electronic devices), including ICDs, CRT-Ds, and pacemakers. In a paper published in Archives of Internal Medicine, Muhammad Sohail and colleagues analyzed Medicare data from more than 200,000 patients admitted for CIED implantation, replacement, or revision in 2007, including  5817 admissions with…

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Approximately 40% of cardiac resynchronization therapy (CRT) devices are implanted in patients with QRS intervals below 150 msecs, but a meta-analysis published in Archives in Internal Medicine finds that these patients may not benefit from the device. Ilke Sipahi and colleagues performed a meta-analysis that included five CRT clinical trials (COMPANION, CARE-HF, REVERSE, MADIT-CRT, RAFT)…

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Cardiac resynchronization therapy (CRT) appears to be beneficial in patients with less severe heart failure (NYHA class I and II), according to a new systematic review published online in Annals of Internal Medicine. In a previous analysis, Nawaf Al-Majed and colleagues had found that CRT was highly beneficial in HF patients with NYHA class III and IV…

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CardioExchange welcomes Arthur Moss, Professor of Medicine at the University of Rochester School of Medicine and lead investigator of the MADIT-CRT trial, to discuss his New England Journal of Medicine editorial on the RAFT trial, in which patients with mild-to-moderate HF were randomized to receive either an ICD alone or ICD plus CRT. It seems…

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RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) randomized 1798 patients with NYHA class II or III heart failure, LVEF < 30%, and a wide QRS complex to either an ICD alone or an ICD-CRT. After a mean followup of 40 months, the rate of death or heart failure hospitalization was 40.3% in the ICD group…

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