Why the study?
Data comparing outcomes between cardiac resynchronization therapy upgrade in patients with LBBB or RV pacing and de novo CRT in LBBB are limited.
Does upgrading to CRT for LBBB or RV pacing improve long-term outcomes compared to de novo CRT for LBBB in heart failure patients?
Does upgrading to CRT for LBBB or RV pacing improve long-term outcomes compared to de novo CRT for LBBB in heart failure patients?
CRT upgrade for LBBB or RV pacing confers less prognostic benefit compared to de novo CRT for LBBB, and left atrial diameter >50 mm identifies those with particularly poor outcomes, highlighting the importance of early CRT upgrading before significant atrial remodeling occurs.
Background: Data comparing outcomes between cardiac resynchronization therapy (CRT) upgrade in patients with left bundle branch block (LBBB) or right ventricular (RV) pacing and de novo CRT in LBBB are limited. Objective: To evaluate long-term outcomes of CRT upgrade in patients with LBBB or RV pacing compared with de novo CRT in LBBB. Methods: We analyzed 395 consecutive patients who received CRT, classified into 3 groups: CRT upgrade for LBBB or RV pacing (Upgrade group, n = 111), de novo CRT for LBBB (LBBB group, n = 84), and CRT for non-LBBB (non-LBBB group, n = 200). The primary end point was a composite of all-cause mortality and heart failure hospitalization. The secondary end point was CRT response, defined as an improvement of ≥15% in left ventricular end-systolic volume. Results: .03). Conclusion: CRT upgrade for LBBB or RV pacing offers less prognostic benefit than de novo CRT for LBBB.
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Oshima et al. (2025) studied this question.
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