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Previous Volume 346:1845-1853 June 13, 2002 Number 24 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Hare, J. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Previous studies have suggested that cardiac resynchronization achieved through atrial-synchronized biventricular pacing produces clinical benefits in patients with heart failure who have an intraventricular conduction delay. We conducted a double-blind trial to evaluate this therapeutic approach.

Methods Four hundred fifty-three patients with moderate-to-severe symptoms of heart failure associated with an ejection fraction of 35 percent or less and a QRS interval of 130 msec or more were randomly assigned to a cardiac-resynchronization group (228 patients) or to a control group (225 patients) for six months, while conventional therapy for heart failure was maintained. The primary end points were the New York Heart Association functional class, quality of life, and the distance walked in six minutes.

Results As compared with the control group, patients assigned to cardiac resynchronization experienced an improvement in the distance walked in six minutes (+39 vs. +10 m, P=0.005), functional class (P<0.001), quality of life (–18.0 vs. –9.0 points, P= 0.001), time on the treadmill during exercise testing (+81 vs. +19 sec, P=0.001), and ejection fraction (+4.6 percent vs. –0.2 percent, P<0.001). In addition, fewer patients in the group assigned to cardiac resynchronization than control patients required hospitalization (8 percent vs. 15 percent) or intravenous medications (7 percent vs. 15 percent) for the treatment of heart failure (P<0.05 for both comparisons). Implantation of the device was unsuccessful in 8 percent of patients and was complicated by refractory hypotension, bradycardia, or asystole in four patients (two of whom died) and by perforation of the coronary sinus requiring pericardiocentesis in two others.

Conclusions Cardiac resynchronization results in significant clinical improvement in patients who have moderate-to-severe heart failure and an intraventricular conduction delay.

Source Information

From the University of Kentucky College of Medicine, Lexington (W.T.A., W.G.F.); Emory University and Crawford Long Hospital, Atlanta (A.L.S., D.B.D., A.R.L.); the University of Pennsylvania, Philadelphia (E.L., D.Z.K.); Columbia University College of Physicians and Surgeons, New York (M.P.); Mayo Medical Center, Rochester, Minn. (A.L.C., D.L.H.); and Long Beach Memorial Medical Center, Long Beach, Calif. (M.E., J.M.).

Other authors were Robin J. Trupp, M.S.N. (University of Kentucky, Lexington), Jackie Underwood, B.S.N. (Emory University and Crawford Long Hospital, Atlanta), Faith Pickering, B.S.N. (University of Pennsylvania, Philadelphia), Cindy Truex, B.S.N. (Mayo Medical Center, Rochester, Minn.), and Peggy McAtee, M.S.N. (Long Beach Memorial Hospital, Long Beach, Calif.).

Address reprint requests to Dr. Abraham at the University of Kentucky College of Medicine, Division of Cardiovascular Medicine, Rm. L-543, Kentucky Clinic, 740 S. Limestone St., Lexington, KY 40536-0284, or at wtabra2{at}uky.edu.

Full Text of this Article

Related Letters:

Cardiac Resynchronization Therapy for Heart Failure
Bax J. J., Van der Wall E. E., Schalij M. J., Gottlieb S. S., Fisher M. L., Abraham W. T., the MIRACLE Study Group
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1803-1804, Nov 28, 2002. Correspondence

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