Author + information
- Received September 12, 2017
- Revision received December 18, 2017
- Accepted January 23, 2018
- Published online March 26, 2018.
- Camilla Normand, BM BCha,b,∗ (, )
- Cecilia Linde, MD, PhDc,
- Jagmeet Singh, MD, PhDd and
- Kenneth Dickstein, MD, PhDa,b
- aCardiology Department, Stavanger University Hospital, Stavanger, Norway
- bInstitute of Internal Medicine, University of Bergen, Bergen, Norway
- cDepartment of Cardiology, Karolinska University Hospital, and Karolinska Institutet Stockholm, Stockholm, Sweden
- dDivision of Cardiology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Camilla Normand, Cardiology Department, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway.
Objectives This study compares and contrasts the recommended indications for cardiac resynchronization therapy (CRT) according to the most recent guidelines from international cardiology societies.
Background CRT has been shown to reduce morbidity and mortality in selected patients with systolic heart failure. Cardiology societies provide guidelines regarding the indications for CRT. As evidence evolves, it is challenging for the guideline committees to review the impact of newer evidence in a timely fashion.
Methods Six of the most recent international guidelines providing recommendation concerning CRT implantation ranging from 2011 to 2017 were reviewed. These included guidelines from 2 European, 1 North American, 1 Canadian, and 1 Australian/New Zealand societies and the National Institute for Health and Care Excellence guidelines, specific to the United Kingdom.
Results Although international societies provide consistent recommendations for most CRT indications, differences are found in recommendations for several important patient populations. Specifically, divergent recommendations exist regarding QRS duration, bundle branch morphology, patients in atrial fibrillation, choice of device type (CRT pacemakers vs. CRT defibrillators), and selected patients who are likely to be dependent on right ventricular pacing. The timing of publication of specific guidelines appears to play an essential role in explaining these disparities.
Conclusions Despite general consistency in international guideline recommendations, there remain certain patient populations for whom there are variations in recommendations concerning eligibility for CRT and selection of the most appropriate device in the individual patient.
Drs. Normand, Linde, Singh, and Dickstein have received research support from Biotronik, Boston Scientific, Medtronic, LivaNova, and Abbott. Dr. Linde has received research support from Astra Zeneca, Swedish Heart-Lung Foundation, and the Stockholm County Council. Dr. Singh is a consultant for Impulse Dynamics and Respicardia.
- Received September 12, 2017.
- Revision received December 18, 2017.
- Accepted January 23, 2018.
- 2018 American College of Cardiology Foundation