{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:08:46Z","timestamp":1791446926141,"version":"4.3.3"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The impact of QRS morphology and duration on the effectiveness of cardiac resynchronization therapy (CRT) has been usually assessed separately. The interaction between these 2 simple ECG parameters and their effect on CRT has not been systematically assessed in a large-scale clinical trial.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              The Resynchronization\u2013Defibrillation for Ambulatory Heart Failure Trial showed that implantable cardioverter defibrillator-CRT was associated with a significant reduction in the primary end point of all-cause mortality or heart failure hospitalization. For this substudy, we excluded patients in atrial fibrillation and those with a previous pacemaker. All baseline ECGs were reviewed by a panel of 3 experienced electrocardiographers. A total of 1483 patients were included in this study. Of these, 1175 had left bundle-branch block (LBBB) and 308 had non-LBBB. In patients with LBBB receiving implantable cardioverter defibrillator-CRT, there was a reduction in the primary outcome and in each individual component of the primary outcome. Furthermore, there was continuous relationship between QRS duration and extent of benefit. In patients with non-LBBB and QRS \u2265160 ms, the hazard ratio for the primary outcome was 0.52 (0.29\u20130.96;\n              <jats:italic>P<\/jats:italic>\n              =0.033); in patients with QRS &lt;160 ms, the hazard ratio was 1.38 (0.88\u20132.14;\n              <jats:italic>P<\/jats:italic>\n              =0.155).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In patients with LBBB, there was a continuous relationship between broader QRS and greater benefit from implantable cardioverter defibrillator-CRT. However, our data do not support the use of implantable cardioverter defibrillator-CRT in patients with non-LBBB, especially when the QRS duration is &lt;160 ms. There may be some delayed benefit when the QRS is \u2265160 ms, but this needs further investigation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00251251.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.113.000380","type":"journal-article","created":{"date-parts":[[2013,8,31]],"date-time":"2013-08-31T04:05:42Z","timestamp":1377921942000},"page":"1190-1198","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":141,"title":["Impact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy"],"prefix":"10.1161","volume":"6","author":[{"given":"David H.","family":"Birnie","sequence":"first","affiliation":[{"name":"From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Ha","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyall","family":"Higginson","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Sidhu","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Green","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Philippon","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Thibault","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal 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