LATE SURVIVAL OF PATIENTS RECEIVING CARDIAC RESYNCHRONIZATION THERAPY DEPENDING ON ECG QRS COMPLEX DURATION

To compare late survival of patients with moderate-to-severe chronic heart failure (CHF) who received cardiac resynchronization therapy (CRT) depending on the QRS complex duration, 122 patients were examined. Group I consisted of 43 patients (41 men) aged 53±1.4 years with QRS duration <120 ms; Group II consisted of 79 patients (68 men) aged 56±1.2 years with QRS duration >120 ms. The follow-up period duration was 24±1.7 months (up to 80 months). The information on the patients’ survival was obtained for 36 patients of Group I (84%) and 60 patients of Group II (76%). Within the follow-up of 43 months, survival of the patients with the “narrow” QRS complex was significantly better than in those with the “wide” QRS complex (76% and 51%, respectively; p=0.03). Then, the survival curves intersected and, by the end of the follow-up period, no statistically significant difference between the study groups was revealed (42% and 66%, p=0.13). During the follow-up period, 7 patients with the “narrow” QRS complex (16%) deceased, including 5 patients (12%) who died within the first 43 months. In the group of patients with the “wide” QRS complexes, 19 patients (24%) deceased, all lethal outcomes occurred within first 43 months of the follow-up. The multivariant analysis showed that atrial fibrillation (AF) significantly worsened outcome of the patients with CHF and radiofrequency ablation, on the contrary, improved survival. The risk of death of patients with AF was three times higher and of those without radiofrequency ablation was twelve times higher. The QRS complex width and presence of angina did not show any effect on survival. Thus, in the real clinical practice, CRT was associated with a better survival of the patients with the “narrow” QRS complex within approximately first three years of follow-up. Later on, the difference diminished and, during a longer follow-up, no statistically significant difference in the survival of the patients with the “narrow” and “wide” QRS complex was revealed. The multivariant analysis data give evidence about the lack of correlation between the QRS complex duration and the patient survival during the long-term follow-up while on CRT.

chronic heart failure, cardiac resynchronization therapy, QRS complex duration, medical treatment, echocardiography

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