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Association between QRS shortening and mortality after implantation of cardiac resynchronization therapy: results from the DANISH study

Session Best graded abstracts

Speaker Casper Lund-Andersen

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Abstract Session
  • FP Number : 850

Authors : C Lund-Andersen (Copenhagen,DK), D Hoefsten (Copenhagen,DK), JJ Thune (Copenhagen,DK), BT Philbert (Copenhagen,DK), JC Nielsen (Aarhus,DK), AM Thoegersen (Aalborg,DK), J Haarbo (Copenhagen,DK), L Videbaek (Odense,DK), JH Svendsen (Copenhagen,DK), S Pehrson (Copenhagen,DK), L Koeber (Copenhagen,DK)

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Authors:
C Lund-Andersen1 , D Hoefsten1 , JJ Thune2 , BT Philbert1 , JC Nielsen3 , AM Thoegersen4 , J Haarbo5 , L Videbaek6 , JH Svendsen1 , S Pehrson1 , L Koeber1 , 1Rigshospitalet - Copenhagen University Hospital - Copenhagen - Denmark , 2Bispebjerg University Hospital, Department og Cardiology - Copenhagen - Denmark , 3Aarhus University Hospital, Department of Cardiology - Aarhus - Denmark , 4Aalborg University Hospital, Department of Cardiology - Aalborg - Denmark , 5Copenhagen University Hospital Gentofte, Department of Cardiology - Copenhagen - Denmark , 6Odense University Hospital, Department of Cardiology - Odense - Denmark ,

Citation:

Background: Changes in QRS-duration (?QRSd) are often used in the clinical setting to assess the effect of Cardiac Resynchronization Therapy (CRT) although an association between ?QRSd and outcome has not been not firmly established.

Purpose: In this sub-study from the Danish randomized, controlled, multicenter study to assess the efficacy of Implantable cardioverter defibrillator in patients with non-ischemic Systolic Heart failure on mortality (DANISH) study, we aimed to assess the association between ?QRSd after implantation of CRT and mortality in a large cohort of patients with non-ischemic cardiomyopathy.

Methods: We included all patients from the DANISH study who received a CRT system (CRT-defibrillator or CRT-pacemaker). The last ECG before implantation and the first available ECG after implantation were used for calculation of ?QRSd. Patients without ECG data were excluded.  ?QRSd did not meet the proportional hazards assumption in the Cox model. The association between ?QRSd and the primary endpoint, all-cause mortality was therefore investigated in two time-intervals:  0-1 year, and beyond one year after CRT

Results: 640 patients were treated with CRT and ECGs were available in 572 patients. Median age was 66 years, 390 (68%) were men and QRSd was 160 milliseconds (ms; IQR 146-180).  An ECG was recorded 48 days (IQR 33-85) after implantation and showed that CRT had resulted in QRSd of 145 ms (IQR 125-160) i.e. ?QRSd of median -14 ms (IQR -38 - 3). Patients were followed for median 4.6 years (IQR 3.0 – 6.1). During the first year of implantation 20 patients died and in this time-interval an 18% reduction in mortality was observed per 10 ms reduction of QRSd (HR 0.82, CI: 0.69 – 0.98, p=0.03). Beyond one year, 86 patients died, but ?QRSd was not associated with additional reduction of mortality (HR 1.07, CI: 0.90-1.04, p=0.14).

Conclusion: In a large cohort of patients with non-ischemic cardiomyopathy reduction of QRSd early after implantation of CRT was associated with reduced mortality within the first year of treatment. Changes in QRSd was not associated with additional mortality reduction beyond the first year.

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