• Yitschak Biton, Wojciech Zareba, Ilan Goldenberg, Helmut Klein, Scott McNitt, Bronislava Polonsky, Arthur J Moss, Valentina Kutyifa, and MADIT‐CRT Executive Committee.
• Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY (Y.B., W.Z., I.G., H.K., S.M.N., B.P., A.J.M., V.K.).
• J Am Heart Assoc. 2015 Jun 29; 4 (7).

BackgroundPrevious studies have shown conflicting results regarding the benefit of cardiac resynchronization therapy (CRT) by sex and QRS duration.Methods And ResultsIn the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated long-term clinical outcome of heart failure (HF) or death, death, and HF alone by sex and QRS duration (dichotomized at 150 ms) in left bundle-branch block patients with CRT with defibrillator backup (CRT-D) versus implantable cardioverter-defibrillator (ICD) only. There were 394 women (31%) and 887 men with left bundle-branch block. During the median follow-up of 5.6 years, women derived greater clinical benefit from CRT-D compared with implantable cardioverter-defibrillator only, with a significant 71% reduction in HF or death (hazard ratio [HR] 0.29, P<0.001) and a 77% reduction in HF alone (HR 0.23, P<0.001) compared with men, who had a 41% reduction in HF or death (HR 0.59, P<0.001) and a 50% reduction in HF alone (HR 0.50, P<0.001) (all sex-by-treatment interaction P<0.05). Men and women had similar reduction in long-term mortality with CRT-D versus implantable cardioverter-defibrillator only (men: HR 0.70, P=0.03; women: HR 0.59, P=0.04). The incremental benefit of CRT-D in women for HF or death and HF alone was consistent with QRS <150 or >150 ms.ConclusionsDuring long-term follow-up of mild HF patients with left ventricular dysfunction and wide QRS, both women and men with left bundle-branch block derived sustained benefit from CRT-D versus implantable cardioverter-defibrillator only, with significant reduction in HF or death, HF alone, and all-cause mortality regardless of QRS duration. There is an incremental benefit with CRT-D in women for the end points of HF or death and HF alone.Clinical Trial RegistrationURL: https://clinicaltrials.gov/. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110.© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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