Abstract
We tested the hypothesis that prophylactic cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker with or without a defibrillator would reduce the risk of death and hospitalization among patients with advanced chronic heart failure and intraventricular conduction delays.
In patients with advanced heart failure and a prolonged QRS interval, cardiac-resynchronization therapy decreases the combined risk of death from any cause or first hospitalization and, when combined with an implantable defibrillator, significantly reduces mortality.
Methods
A total of 1520 patients who had advanced heart failure (New York Heart Association class III or IV) due to ischemic or nonischemic cardiomyopathies and a QRS interval of at least 120 msec were randomly assigned in a 1:2:2 ratio to receive optimal pharmacologic therapy (diuretics, angiotensin-converting–enzyme inhibitors, beta-blockers, and spironolactone) alone or in combination with cardiac-resynchronization therapy with either a pacemaker or a pacemaker–defibrillator. The primary composite end point was the time to death from or hospitalization for any cause.
Authors
Michael R. Bristow, M.D., Leslie A. Saxon, M.D., John Boehmer, M.D., Steven Krueger, M.D., David A. Kass, M.D., Teresa De Marco, M.D., Peter Carson, M.D., Lorenzo DiCarlo, M.D., David DeMets, Ph.D., Bill G. White, Ph.D., Dale W. DeVries, B.A., Arthur M. Feldman, M.D., Ph.D. Investigators
Citation
New England Journal of Medicine 2004. 350:2140-50.