Key result
CRT may improve symptoms and survival beyond advanced systolic HF, including in mild-to-moderate cases.
Why the study?
Does cardiac resynchronization therapy provide symptomatic and mortality benefits in patients outside standard advanced systolic heart failure criteria?
Does cardiac resynchronization therapy provide symptomatic and mortality benefits in patients outside standard advanced systolic heart failure criteria?
CRT may offer symptomatic and mortality benefits in expanded patient populations beyond current advanced systolic heart failure guidelines, though further trials are needed.
Cardiac resynchronization therapy (CRT) is an effective therapy for advanced heart failure (HF) patients. The indications are well defined in recent guidelines and broadly indicate that CRT is suitable for chronic HF patients with left ventricular ejection fraction (EF) ≤35% and in NYHA class III or IV (Class I), and those with prolonged QRS duration ≥120 ms with left bundle branch block (LBBB) QRS morphology, or QRS duration ≥150 ms irrespective of QRS morphology (Class IIa). For patients with NYHA class II symptoms, CRT is recommended for patients with EF ≤30% and QRS duration ≥130 ms with LBBB QRS morphology (Class I, level of evidence: A), or QRS duration ≥150 ms irrespective of QRS morphology (Class IIa, level of evidence: A). However, CRT may benefit additional patients outside these criteria. In this review, we summarize the role of CRT in some subgroups, including patients with mild and moderate HF, upgrading to CRT from right ventricular (RV) pacing, bradycardia patients with routine pacing indications, congenital heart disease and specific cardiomyopathies. It is possible that CRT can give symptomatic and mortality benefits in some of these subgroups in the future and further clinical trials are warranted.
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Fang et al. (2013) conducted a review in Heart failure and other cardiac conditions requiring pacing. Cardiac resynchronization therapy (CRT) vs. Standard therapy or right ventricular pacing was evaluated. Cardiac resynchronization therapy may provide symptomatic and mortality benefits in patient subgroups beyond advanced systolic heart failure, including those with mild to moderate heart failure, bradycardia, and specific cardiomyopathies.
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