{"id":36529,"date":"2013-05-12T13:54:38","date_gmt":"2013-05-12T17:54:38","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=36529"},"modified":"2013-05-14T09:27:41","modified_gmt":"2013-05-14T13:27:41","slug":"how-should-recent-trials-affect-crt-practice","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/05\/12\/how-should-recent-trials-affect-crt-practice\/","title":{"rendered":"How Should Recent Trials Affect CRT Practice?"},"content":{"rendered":"

In recent weeks the cardiac resynchronization therapy (CRT) field has been absorbing the publication of the BLOCK HF trial<\/a> <\/strong>in the <\/em>New England Journal of Medicine and the publication of the NARROW-CRT trial<\/strong><\/a> in <\/em>Circulation: Arrhythmia and Electrophysiology. These trials raised the possibility that CRT may improve clinical status in some patients with ischemic cardiomyopathy and narrow QRS. At the same time, however, news emerged that the EchoCRT trial<\/a><\/strong>, which was looking at CRT in HF patients with QRS <130 msec, had been stopped due to futility. CardioExchange’s John Ryan<\/strong> asked Duke’s Sana Al-Khatib<\/strong> to answer questions about these developments.<\/em><\/p>\n

Ryan:<\/strong> Are the data from BLOCK HF sufficient to change your practice? In patients with AV block and decreased EF, are you going to be recommend CRT placement? Or have you been doing so already?<\/p>\n

Al-Khatib:<\/strong> BLOCK-HF was a well-designed and conducted trial. In general, we require more than one good trial to change practice; however, given these data from BLOCK-HF and the convincing data on the potential deleterious effects of right ventricular pacing from different studies, I personally think it is best to implant a biventricular device in patients who meet the entry criteria of the BLOCK-HF trial. We have not been implanting a CRT device in such patients. I expect the results of BLOCK-HF to change practice.<\/p>\n

Ryan:<\/strong> Why are there discrepant results in CRT on patients with narrow QRS? What is your opinion on the effects of CRT in HF patients with narrow QRS?<\/p>\n

Al-Khatib:<\/strong> I have concerns about the NARROW-CRT trial that range from the relatively small sample size, to the integrity of blinding, to the methodology they used to determine dyssynchrony. When the EchoCRT trial was stopped due to futility, my understanding is that the trial had a much larger number of patients than the patients enrolled in NARROW-CRT (close to or more than 1000 patients in Echo CRT compared with only 111 patients in NARROW CRT). Although the results have not been published, and I cannot give my final assessment of EchoCRT until I see the data, I have to infer, based on the resources and expertise invested in EchoCRT, that CRT is not likely at all to be beneficial in patients with a narrow QRS. Therefore, we, as a medical community, should focus our efforts on other patient populations.<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

In recent weeks the cardiac resynchronization therapy (CRT) field has been absorbing the publication of the BLOCK HF trial in the New England Journal of Medicine and the publication of the NARROW-CRT trial in Circulation: Arrhythmia and Electrophysiology. These trials raised the possibility that CRT may improve clinical status in some patients with ischemic cardiomyopathy […]<\/p>\n","protected":false},"author":736,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[1808,542,1786,1785,876],"class_list":["post-36529","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","tag-block-hf","tag-crt","tag-echocrt","tag-narrow-crt","tag-qrs"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36529","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/736"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=36529"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36529\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=36529"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=36529"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=36529"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}