May 21, 2023American Heart JournalOpen Access

Does targeted positioning of the left ventricular pacing lead towards the latest local electrical activation in cardiac resynchronization therapy reduce the incidence of death or hospitalization for heart failure?

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Heart failure with reduced ejection fraction and bundle branch block (n=1000). Intervention: Targeted positioning of the left ventricular lead to the latest local electrical activation vs. Conventional left ventricular lead positioning in a nonapical posterolateral branch. Primary outcome: Composite of death and nonplanned heart failure hospitalization.

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Key result

The DANISH-CRT trial is an ongoing randomized controlled trial designed to evaluate whether targeted positioning of the left ventricular lead to the latest local electrical activation reduces death or heart failure hospitalization.

Why the study?

Up to one third of patients derive no clinical benefit from CRT, and mapping-guided LV lead placement towards the site of latest electrical activation had never been evaluated in an RCT.

Does targeted positioning of the LV lead towards the latest local electrical activation reduce the composite of death and nonplanned HF hospitalization in patients undergoing CRT implantation or upgrade?

Population

1,000 patients referred for de novo CRT implantation or upgrade to CRT from right ventricular pacing

Comparison

Targeted LV lead positioning to latest electrical activation vs conventional LV lead positioning

Design

National, double-blinded RCT

Follow-up

Minimum of 2 years and until 264 primary endpoints occurred

Authors

MKMads Brix KronborgElectrophysiology MFMaria Hee Jung Park FrausingAarhus University JSJesper Hastrup SvendsenElectrophysiology

Discussion

Member takes

Implication

Targeting LV lead to latest activation may improve CRT response; extends observational data with first RCT evidence.

Study Design

Type

RCT (n=1,000)

Blinding

Double-blind

Randomization

1:1 block-randomization

Multicenter

Yes

Structured PICO

Population

1,000 planned patients over 40 years of age with symptomatic heart failure, LVEF ≤35%, and bundle branch block, followed for a minimum of 2 years.

Intervention

Targeted positioning of the LV lead to the coronary sinus branch with the latest local electrical LV activation using electrical mapping

Comparator

Conventional LV lead positioning preferably in a nonapical posterolateral branch of the coronary sinus

Outcome

Composite of death and nonplanned HF hospitalizationcomposite

The DANISH-CRT trial is an ongoing randomized controlled trial evaluating whether mapping-guided LV lead positioning to the latest electrically activated area improves clinical outcomes compared to standard placement.

Limitations

Study is ongoing and results are not yet available
Coronary sinus mapping may prolong the implantation procedure and increase radiation exposure
Not powered to detect a significant reduction in mortality alone

Cite This Study

Kronborg et al. (2023) conducted an RCT in Heart failure with reduced ejection fraction and bundle branch block (n=1,000). Targeted positioning of the left ventricular lead to the latest local electrical activation vs. Conventional left ventricular lead positioning in a nonapical posterolateral branch was evaluated on Composite of death and nonplanned heart failure hospitalization. The DANISH-CRT trial is an ongoing randomized controlled trial designed to evaluate whether targeted positioning of the left ventricular lead to the latest local electrical activation reduces death or heart failure hospitalization.

synapsesocial.com/papers/6a5dbedd7c13578e3bc4dfe2 https://doi.org/10.1016/j.ahj.2023.05.011

Topics

Heart failure hospitalization HFrEF treatment Heart failure

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Does targeted positioning of the left ventricular pacing lead towards the latest local electrical activation in cardiac resynchronization therapy reduce the incidence of death or hospitalization for heart failure?

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Does targeted positioning of the left ventricular pacing lead towards the latest local electrical activation in cardiac resynchronization therapy reduce the incidence of death or hospitalization for heart failure?

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

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Topics

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