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Resynchronization Therapy for Chronic Heart Failure?
Resynchronization devices benefited heart-failure patients who were receiving standard medical therapy.
Abnormalities of cardiac conduction associated with widening of the QRS complex are common in heart failure patients. Results of small studies have suggested that resynchronization, through pacing of both the left and right ventricle, is beneficial. In this industry-supported, double-blind, multicenter U.S. study, 453 patients with moderate-to-severe heart failure, ejection fractions of <35%, and QRS durations of 130 msec or more were randomized to biventricular pacing or to receive resynchronization devices that were not programmed (control group). In addition, all patients received standard medical therapy for heart failure. Pacemakers could not be implanted in 8% of eligible patients, and 4 patients had serious complications resulting from implantation (2 died).
At 6 months, patients in the resynchronization group had significantly greater improvement in distance walked in 6 minutes (median, 39 m vs. 10 m), functional class, quality of life, exercise duration during treadmill testing (81 sec vs. 19 sec) and ejection fraction (+4.6% vs. -0.02%) than did those in the control group. Significantly fewer patients in the resynchronization group were hospitalized (8% vs. 15%) or treated with intravenous medications for heart failure (7% vs. 15%).
Comment: These results suggest that a mechanical therapy, such as biventricular pacing, improves functional status and quality of life in patients with heart failure, depressed ejection fraction, and dyssynchrony. As an editorialist points out though, important questions remain, such as the longer-term effects of resynchronization therapy on outcome (particularly survival) and the proper role of combined resynchronization and defibrillator devices. Ongoing, large-scale trials should give us more answers.
— Kirsten E. Fleischmann, MD, MPH
Published in Journal Watch General Medicine June 21, 2002
Citation(s):
Abraham WT et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002 Jun 13; 346:1845-53.
- Medline abstract (Free)
Hare JM. Cardiac-resynchronization therapy for heart failure. N Engl J Med 2002 Jun 13; 346:1902-5.
- Medline abstract (Free)
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