Rethinking QRS Duration as an Indication for CRT
SMITA MEHTA M.D.,
SAMUEL J. ASIRVATHAM M.D., F.A.C.C.,
SMITA MEHTA M.D.
Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
Search for more papers by this authorSAMUEL J. ASIRVATHAM M.D., F.A.C.C.
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
Search for more papers by this authorSMITA MEHTA M.D.,
SAMUEL J. ASIRVATHAM M.D., F.A.C.C.,
SMITA MEHTA M.D.
Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
Search for more papers by this authorSAMUEL J. ASIRVATHAM M.D., F.A.C.C.
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
Search for more papers by this authorSamuel J. Asirvatham, M.D., Division of Cardiovascular Diseases, Department of Internal Medicine and Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. E-mail: [email protected]
J Cardiovasc Electrophysiol, Vol. 23, pp. 169-171, February 2012.
No disclosures.

References
- 1 Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J: Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-666.
- 2 Crandall MA, Bradley DJ, Packer DL, Asirvatham SJ: Contemporary management of atrial fibrillation: Update on anticoagulation and invasive management strategies. Mayo Clin proc Mayo Clin 2009; 84: 643-662.
- 3 Abraham WT: Rationale and design of a randomized clinical trial to assess the safety and efficacy of cardiac resynchronization therapy in patients with advanced heart failure: The Multicenter InSync Randomized Clinical Evaluation (MIRACLE). J Card Fail 2000; 6: 369-380.
- 4 Blanc JJ, Etienne Y, Gilard M, Mansourati J, Munier S, Boschat J, Benditt DG, Lurie KG: Evaluation of different ventricular pacing sites in patients with severe heart failure: Results of an acute hemodynamic study. Circulation 1997; 96: 3273-3277.
- 5 Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, Hohnloser SH, Nichol G, Birnie DH, Sapp JL, Yee R, Healey JS, Rouleau JL: Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010; 363: 2385-2395.
- 6 Pitzalis MV, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G, Guida P, Andriani A, Mastropasqua F, Rizzon P: Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 2002; 40: 1615-1622.
- 7 Achilli A, Sassara M, Ficili S, Pontillo D, Achilli P, Alessi C, De Spirito S, Guerra R, Patruno N, Serra F: Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS. J Am Coll Cardiol 2003; 42: 2117-2124.
- 8 Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J 3rd, St John Sutton M, De Sutter J, Murillo J: Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008; 117: 2608-2616.
- 9 Henz BD, Friedman PA, Bruce CJ, Okumura Y, Johnson SB, Danielsen A, Packer DL, Asirvatham SJ: Synchronous ventricular pacing without crossing the tricuspid valve or entering the coronary sinus—preliminary results. J Cardiovasc Electrophysiol 2009; 20: 1391-1397.
- 10 Tournoux F, Donal E, Leclercq C, De Place C, Crocq C, Solnon A, Cohen-Solal A, Mabo P, Daubert JC: Concordance between mechanical and electrical dyssynchrony in heart failure patients: A function of the underlying cardiomyopathy? J Cardiovasc Electrophysiol 2007; 18: 1022-1027.
- 11 Stavrakis S, Lazzara R, Thadani U: The benefit of cardiac resynchronization therapy and QRS duration: A meta-analysis. J Cardiovasc Electrophysiol; In this issue. DOI: 10.1111/j.1540-8167.2011.02144.x
- 12 Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM: Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140-2150.
- 13 Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L: The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539-1549.
- 14 Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C: Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol 2008; 52: 1834-1843.
- 15 Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, Estes NA, 3rd, Foster E, Greenberg H, Higgins SL, Pfeffer MA, Solomon SD, Wilber D, Zareba W: Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009; 361: 1329–1338.
- 16 Schimpf R, Antzelevitch C, Haghi D, Giustetto C, Pizzuti A, Gaita F, Veltmann C, Wolpert C, Borggrefe M: Electromechanical coupling in patients with the short QT syndrome: Further insights into the mechanoelectrical hypothesis of the U wave. Heart Rhythm: Official J Heart Rhythm Soc 2008; 5: 241-245.
- 17 Beshai JF, Grimm RA, Nagueh SF, Baker JH, 2nd, Beau SL, Greenberg SM, Pires LA, Tchou PJ: Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 2007; 357: 2461-2471.
- 18 Zannad F, Huvelle E, Dickstein K, van Veldhuisen DJ, Stellbrink C, Kober L, Cazeau S, Ritter P, Maggioni AP, Ferrari R, Lechat P: Left bundle branch block as a risk factor for progression to heart failure. Eur J Heart Fail 2007; 9: 7-14.
- 19 Garmel GM: Wide complex tachycardias: Understanding this complex condition. Part 2—management, miscellaneous causes, and pitfalls. Western J Emerg Med 2008; 9: 97-103.
- 20 Garmel GM: Wide complex tachycardias: understanding this complex condition. Part 1—epidemiology and electrophysiology. Western J Emerg Med 2008; 9: 28-39.
- 21 Asirvatham SJ: Implantation of cardiac resynchronization devices. In: M Sutton, JJ Bax, M Jessup, J Brugada, M Schallij (eds.): Cardiac Resynchronization Therapy. London : Informa Healthcare; 2007, pp. 109-144.
- 22 Dendy KF, Powell BD, Cha YM, Espinosa RE, Friedman PA, Rea RF, Hayes DL, Redfield MM, Asirvatham SJ: Anodal stimulation: An underrecognized cause of nonresponders to cardiac resynchronization therapy. Indian Pacing Electrophysiol J 2011; 11: 64-72.
- 23 Hayes DL, Boehmer JP, Day J, Gilliam FR, 3rd, Heidenreich PA, Seth M, Jones PW, Saxon LA: Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival. Heart Rhythm: Official J Heart Rhythm Soc 2011.
- 24 Friedman PA, Rott M, Wokhlue A, Asirvatham SJ, Hayes DL: Case-Based Approach to Pacemakers, ICDs, and Cardiac Resynchronization. Minneapolis : Cardiotext, 2011.
- 25 Boriani G, Biffi M, Martignani C, Valzania C, Diemberger I, Bertini M, Domenichini G, Ziacchi M, Branzi A: Is cardiac resynchronization therapy cost-effective?Europace 2009; 11(Suppl 5): v93-v97.