'This is a population that has not gotten a lot of attention,' said an expert. Upgrading their pacemakers to a cardiac resynchronization device may be the answer for some.
, Merkely observed, and were among a range of prospectively defined subgroups that appeared to benefit from CRT-D about as much as the overall study population.
"The impressive results of the BUDAPEST-CRT upgrade study are likely to influence future guidelines and clinical practice," Linde"The study clearly shows that upgrading to CRT is associated with improved outcome," she writes."The results have implications for the organization of pacemaker and ICD follow-up to detect LV deterioration before HF develops and enable upgrading to CRT.
But one lesson from BUDAPEST-CRT, Tung said, may be that"we need to be reducing the threshold, based on historical data, from 40% to 20%."Entry criteria, beyond HFrEF and RV pacing, included an LV ejection fraction 35% or lower, prior implantation with a non-CRT pacemaker or ICD, and a paced QRS interval of at least 150 ms — all on optimal HF medical therapy.
By intention-to-treat, however, 32.4% and 78.9% of the CRT-D and ICD groups, respectively, met the primary outcome over a median of 12.4 months, for an odds ratio of 0.11 .
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