Key result
Cardiac resynchronization therapy provides the most benefit for heart failure patients with a wide QRS (>150 ms) and left bundle branch block, whereas it may be harmful in those with QRS <130 ms.
Why the study?
Indications for cardiac resynchronization therapy have expanded to milder heart failure and other subgroups, while evidence clarifies which patients benefit most and questions whether combined defibrillating devices offer mortality benefit over CRT pacing alone.
Does cardiac resynchronization therapy improve outcomes in heart failure patients with ventricular conduction delay?
Does cardiac resynchronization therapy improve outcomes in heart failure patients with ventricular conduction delay?
This review highlights that CRT benefits are most pronounced in HF patients with wide QRS (>150 ms) and LBBB, while potentially harmful in narrow QRS (<130 ms), and emphasizes tailoring CRT-P vs CRT-D decisions to individual patient profiles.
Cardiac resynchronization therapy (CRT) has rapidly evolved as a standard therapy for heart failure (HF) patients with ventricular conduction delay. Although in early trials, only patients with sinus rhythm and advanced stages of HF have been candidates for CRT, more recent data have expanded the indications to patients with mild-to-moderate HF and atrial fibrillation and patients in need of antibradycardia pacing with reduced left ventricular function. On the other hand, it is now well recognized that patients with a wide QRS (>150 ms) and left bundle branch block morphology benefit most from CRT, whereas in patients with a more narrow QRS complex (<130 ms) CRT may actually be harmful despite the evidence of ventricular dyssynchrony by echocardiography. There is no prospective randomized study showing mortality benefit from a combined CRT defibrillating device over a CRT pacer alone. This is especially important because recent data indicate that older patients with non-ischaemic cardiomyopathy may not benefit from the implantable cardioverter-defibrillator as much as previously thought. Thus, the decision for a CRT pacer versus CRT defibrillating should be tailored to the therapeutic goal (improvement in prognosis versus symptomatic relief), patient age, underlying cardiac disease and comorbidities. This article gives an overview over the current indications for CRT according to published literature and the European guidelines for pacing and HF.
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Lawin et al. (2019) conducted a review in Heart failure. Cardiac resynchronization therapy was evaluated. Cardiac resynchronization therapy provides the most benefit for heart failure patients with a wide QRS (>150 ms) and left bundle branch block, whereas it may be harmful in those with QRS <130 ms.
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