Key result
CRT evolved over 20 years from early case series to blinded trials improving heart failure symptoms.
Why the study?
Cardiac resynchronization therapy was initially applied around 20 years ago as a last-resort treatment in patients with severe heart failure associated with LBBB, despite early lead limitations, and rapidly progressed from case reports to randomized controlled trials.
Answers are grounded in this paper and cite their sources.
Cardiac resynchronization therapy (CRT) was tested in pioneering experiences performed in France around 20 years ago. This electrical treatment was initially applied as a last resort treatment in patients with severe heart failure associated with left bundle branch block (LBBB). Despite the novelty of the approach and the limitations of implantable leads in those early stages, biventricular pacing rapidly moved from case report, and case series to randomized controlled trials (RCTs) such as MUSTIC study and to a RCT with blinded assessment of the effects, that is the MIRACLE study. The MIRACLE trial included implant of a CRT device followed by randomization to biventricular pacing ‘on’ or ‘off’ for 6 months with blinded assessment of the presence/absence of improvement in symptoms, heart failure status and quality of life.
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Boriani et al. (2014) conducted a review in Severe heart failure associated with left bundle branch block (LBBB). Cardiac resynchronization therapy (CRT) / biventricular pacing vs. Biventricular pacing 'off' (in the referenced MIRACLE trial) was evaluated on Improvement in symptoms, heart failure status, and quality of life (in the referenced MIRACLE trial). Cardiac resynchronization therapy evolved over 20 years from pioneering case series in severe heart failure with LBBB to 6-month blinded RCTs assessing symptoms and quality of life.
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