Evidence map›Paper›PMID 28427578›Full record

ArticleJournal of the American College of Cardiology2017

Implantable Cardioverter-Defibrillators With Versus Without Resynchronization Therapy in Patients With a QRS Duration >180 ms.

Varun Sundaram, Jayakumar Sahadevan, Albert L Waldo, George J Stukenborg, Yogesh N V Reddy, Samuel J Asirvatham, Judith A Mackall, Anselma Intini, Brigid Wilson, Daniel I Simon and 1 more

Erratum issuedAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.0field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 13 citations in OpenAlex.

  1. Article
  2. The Treatment of Heart Failure with Reduced Ejection Fraction.Deutsches Arzteblatt international · 2020
    Review
  3. Article
  4. Review
  5. Article
  6. Cardiac Resynchronization Therapy-Emerging Therapeutic Approaches.Current treatment options in cardiovascular medicine · 2018
    Review
  7. Multisite cardiac resynchronization therapy for traditional and non-traditional indications.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2018
    Article
  8. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 2 countries.

Varun SundaramHarrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Jayakumar SahadevanHarrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio. Electronic address: jxs47@case.edu.
Albert L WaldoHarrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
George J StukenborgDivision of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.
Yogesh N V ReddyDivision of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Samuel J AsirvathamDivision of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Judith A MackallHarrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Anselma IntiniDepartment of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio.
Brigid WilsonDepartment of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio.
Daniel I SimonHarrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Kenneth C BilchickDivision of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.
University Hospitals of Cleveland · USLouis Stokes Cleveland VA Medical Center · USMayo Clinic · USUniversity of Virginia Health System · US

Funding

CARDIOVASOLOGYT32HL007111 · NHLBI · MAYO CLINIC ROCHESTER · PI Barry A. Borlaug · 1985 to 2026
$8.7M
Cardiac Magnetic Resonance Imaging After Cardiac Resynchronization TherapyR03HL135463 · NHLBI · UNIVERSITY OF VIRGINIA · PI BILCHICK, KENNETH C · 2016 to 2017
$127k
NHLBI NIH HHS R03 HL135463NHLBI NIH HHS T32 HL007111
6 · The paper itself

Abstract

backgroundMore than 20% of Medicare beneficiaries receiving cardiac resynchronization therapy defibrillators (CRT-D) have a very wide (≥180 ms) QRS complex duration (QRSD). Outcomes of CRT-D in these patients are not well-established because they have been underrepresented in clinical trials.

objectivesThis study examined outcomes in patients with CRT-D in a very wide QRSD with left bundle branch block (LBBB) versus those without LBBB.

methodsMedicare patients from the Implantable Cardioverter Defibrillator Registry (January 1, 2005, through April 30, 2006) with a CRT-D and confirmed Class I or IIa indications for CRT-D were matched to implantable cardioverter-defibrillator (ICD) patients without CRT despite having Class I or IIa indications for CRT. Mortality and heart failure hospitalizations longer than 4 years with CRT-D versus standard ICDs based on a QRSD and morphology were analyzed.

resultsWe analyzed 24,960 patients. Among those with LBBB, patients with a QRSD ≥180 ms had a greater adjusted survival benefit with CRT-D versus standard ICD (hazard ration [HR] for death: 0.65; 95% confidence interval [CI]: 0.59 to 0.72) compared with those having a QRSD 120 to 149 ms (HR: 0.85; 95% CI: 0.80 to 0.92) and 150 to 179 ms (HR: 0.87; 95% CI: 0.81 to 0.93). CRT-D versus ICD was associated with an improvement in survival in those with LBBB and a QRSD ≥180 ms (adjusted HR for death: 0.78; 95% CI: 0.68 to 0.91), but not in those with LBBB and a QRSD 150 to 179 ms (adjusted HR for death: 1.06; 95% CI: 0.95 to 1.19).

conclusionsImprovements in both survival and heart failure hospitalizations with CRT-D were greatest in patients with a QRSD ≥180 ms with or without LBBB, whereas patients with a QRSD 150 to 179 ms without LBBB had no improvement in survival with CRT-D, and those with a QRSD 150 to 179 ms and LBBB had only a modest improvement.

Indexed as

Cardiac Resynchronization TherapyCardiac Resynchronization Therapy DevicesDefibrillators, ImplantableAgedAged, 80 and overBundle-Branch BlockCohort StudiesElectrocardiographyFemaleHumansMaleMiddle AgedTreatment Outcomebundle branch blockcardiac resynchronization therapyheart failureoutcomesvery wide QRS complex

Identifiers

PMID28427578
PMCPMC6834434
OpenAlexW2605401289

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.