Article Text

other Versions

PDF
Original article
Cardiac resynchronisation therapy is not associated with a reduction in mortality or heart failure hospitalisation in patients with non-left bundle branch block QRS morphology: meta-analysis of randomised controlled trials
  1. Colin Cunnington1,
  2. Chun Shing Kwok2,
  3. Duwarakan K Satchithananda3,
  4. Ashish Patwala3,
  5. Muhammad A Khan1,
  6. Amir Zaidi1,
  7. Fozia Z Ahmed1,2,
  8. Mamas A Mamas1,2,4
  1. 1Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
  2. 2Cardiovascular Institute, University of Manchester, Manchester, UK
  3. 3Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, UK
  4. 4Farr Institute, University of Manchester, Manchester, UK
  1. Correspondence to Dr Colin Cunnington, Specialist Registrar in Cardiology, Manchester Royal Infirmary, Manchester M13 9WL, UK; colincunnington{at}aol.com

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 Six RCTs were analysed, including 6914 participants (1683 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 1.09, 95% CI 0.85 to 1.39).

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.

View Full Text

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles