Key result
Cardiac resynchronization therapy significantly reduced all-cause mortality (10.9% vs 16.3%) compared to non-CRT treatments in patients with heart failure and left ventricular systolic dysfunction.
Why the study?
Approximately a third of eligible patients fail to benefit from CRT, warranting a review of published evidence on mechanisms, indications, benefits, and challenges.
Does cardiac resynchronization therapy improve cardiac function, functional capacity, and survival in patients with chronic systolic heart failure and ventricular dyssynchrony?
Meta-Analysis (n=8,288)
Does cardiac resynchronization therapy improve cardiac function, functional capacity, and survival in patients with chronic systolic heart failure and ventricular dyssynchrony?
Absolute Event Rate: 10.9% vs 16.3%
CRT is an effective therapy for chronic systolic heart failure with ventricular dyssynchrony, but improved patient selection and device optimization are needed to reduce the non-responder rate.
Supports CRT consideration in systolic HF; reinforces prior RCTs on mortality benefit.
Substantial medical evidence supports the routine use of cardiac resynchronization therapy (CRT) for treating patients with chronic systolic heart failure (HF) and ventricular dyssynchrony. Through bi-ventricular pacing, CRT is able to synchronize the global ventricular depolarization and to improve contractile function and mitral regurgitation. It is the onlyHF therapy that simultaneously improves cardiac function and functional capacity as well as reduces hospitalization and prolongs survival. However, approximately a third of patients eligible for CRT fail to benefit from treatment possibly due to selection based only on New York Heart association functional class, LVEF, and QRS duration and morphology. Thus, careful patient selection, appropriate left ventricular lead implantation and optimal device programming may improve treatment benefits. This paper reviews published evidence on the CRT including its mechanism of action, indications, therapeutic benefits and challenges as well as identifies areas that would benefit from future research.
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Aref Albakri (2019) conducted a meta-analysis in Heart failure with left ventricular systolic dysfunction (n=8,288). Cardiac resynchronization therapy (CRT) vs. Optimal medical therapy, inactive pacing, or ICD was evaluated on All-cause mortality. Cardiac resynchronization therapy significantly reduced all-cause mortality (10.9% vs 16.3%) compared to non-CRT treatments in patients with heart failure and left ventricular systolic dysfunction.
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