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When CRT is used in patients with narrow QRS complex - evidence from the ESC/EHRA/HFA CRT Survey II

Session Moderated ePosters 7: contemporary cardiac resynchronization therapy: is there room for improvement?

Speaker Dennis Lawin

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Moderated Posters
  • FP Number : 684

Authors : D Lawin (Bielefeld,DE), CM Linde (Stockholm,SE), K Dickstein (Stavanger,NO), C Normand (Stavanger,NO), N Bogale (Stavanger,NO), M Gasparini (Milan,IT), C Sticherling (Basel,CH), M Gwechenberger (Vienna,AT), M Sterlinski (Warsaw,PL), C Blomstroem-Lundqvist (Uppsala,SE), R Sheahan (Cork,IE), G Filippatos (Athens,GR), C Stellbrink (Bielefeld,DE)

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Authors:
D Lawin1 , CM Linde2 , K Dickstein3 , C Normand3 , N Bogale3 , M Gasparini4 , C Sticherling5 , M Gwechenberger6 , M Sterlinski7 , C Blomstroem-Lundqvist8 , R Sheahan9 , G Filippatos10 , C Stellbrink1 , 1Bielefeld Hospital, Cardiology and Intensive Care Medicine - Bielefeld - Germany , 2Karolinska Institute - Stockholm - Sweden , 3University of Stavanger - Stavanger - Norway , 4UOS of Milan and Humanitas Clinical and Research Center - Milan - Italy , 5University Hospital Basel - Basel - Switzerland , 6Medical University of Vienna - Vienna - Austria , 7Cardinal Stefan Wyszynski Institute of Cardiology - Warsaw - Poland , 8Uppsala University Hospital - Uppsala - Sweden , 9University College Cork - Cork - Ireland , 10University of Athens - Athens - Greece ,

Citation:

Introduction: Current guidelines advocate the use of CRT only in patients with heart failure (HF) and a QRS width (QRSw) >130 ms. The ESC/EHRA CRT Survey II collected data on current implantation practice of CRT devices in 42 European countries. This analysis focuses on implementation of CRT with regard to baseline QRS width. 
Methods and Results: Data from 11,088 pts with a de novo implantation or upgrade from a previous device between 2015 and 2017 have been collected. Baseline QRSw was available in 7,481 pts. QRSw <120 ms at implant was present in 9.5%, 120-129 ms in 6.8%, 130-149 ms in 23.7% and of >150 ms in 60%. The table shows information on baseline characteristics and indication. In patients with a QRSw <130 ms CRT indication was most often HF with a primary indication for implantable cardioverter-defibrillator (ICD) or a pacemaker (pm) indication with expected high rate of right ventricular (RV) pacing. Implant success and complications did not differ between groups. At discharge, pts were more likely to receive loop diuretics, ACE inhibitors and aldosterone antagonists with increasing QRS width (p<0.00001 each).
Conclusion: More than 15% of pts in Europe receive a CRT device despite a baseline QRSw < 130 ms which is currently not a guideline-recommended CRT indication. In most of these pts CRT is implanted because of a primary ICD indication or presumed necessity of ventricular pacing in pts with a reduced LV function either because of AV conduction disturbances or atrial fibrillation (AF) requiring AV node ablation.

QRS width <120 ms 120-129 ms 130-149 ms 150-179 ms p-value
Demographics Age (years) ±SD 68.1±11.3 69.3±10.4 68.7±10.6 68.1±10.6 0.05236
NICM (%) 46.9 43.3 45.4 51.9 0.00013
AF (%) 66.4 48.8 42.3 33.5 <0.00001
Previous device (%) 20.8 20.6 16.8 15.8 0.001
Mean EF (%) ± SD 32.8±9.6 29.4±8.8 28.4±7.9 27.9±7.5 <0.00001
Baseline ECG AV block II/III (%) 23.8 17.8 12.0 9.1 <0.00001
LBBB (%) 15.7 52.3 73.2 83.6 <0.00001
PM dependent (%) 5.6 4.0 2.9 2.1 <0.00001
Indication HF with wide QRS (%) 6.8 36.3 58.6 70.9 <0.00001
HF and ICD indic. (%) 43.2 52.8 53.3 49.7 0.00006
Expected RV pacing depend. (%) 56.7 34.9 21.3 12.6 <0.00001
Mechanical dyssynchrony (%) 4.7 9.0 9.9 12.3 <0.00001
Demographics, baseline ecg and indication. LBBB = left bundle branch block; EF = ejection fraction; NICM = non-ischemic cardiomyopathy; SD = standard deviation.


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