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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic

Cecilia Linde1, William T Abraham2, Michael R Gold3

  • 1Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.

Journal of the American College of Cardiology
|November 29, 2008
PubMed

Insights

Cardiac resynchronization therapy (CRT) significantly improves heart structure and function, reducing hospitalizations for heart failure (HF) in patients with NYHA class I/II symptoms. This therapy offers a vital option for managing HF progression.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is established for advanced heart failure (NYHA class III/IV).
  • Previous studies show CRT improves left ventricular (LV) function and outcomes in severe heart failure.
  • The benefit of CRT in earlier stages of heart failure (NYHA class I/II) requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy of CRT in patients with NYHA functional class II and class I (ACC/AHA stage C) heart failure.
  • To assess the impact of CRT on clinical composite response, LV remodeling, and HF hospitalizations.
  • To determine if CRT provides benefits in patients with less advanced heart failure symptoms.

Main Methods:

  • A randomized controlled trial involving 610 patients with NYHA class I/II heart failure and prolonged QRS (> or =120 ms).
  • Patients received CRT devices and were assigned to active CRT (CRT-ON) or control (CRT-OFF) for 12 months.
  • Primary endpoint: HF clinical composite response; Secondary endpoints: LV end-systolic volume index and HF hospitalization rates.

Main Results:

  • While the primary composite endpoint did not reach statistical significance for worsening (16% CRT-ON vs. 21% CRT-OFF, p=0.10), CRT-ON showed significant improvement in LV end-systolic volume index (p < 0.0001).
  • CRT significantly reduced the risk of hospitalization for worsening heart failure (HR: 0.47, p=0.03).
  • Positive trends in LV remodeling and functional status were observed with CRT.

Conclusions:

  • CRT, alongside optimal medical therapy, is effective in reducing heart failure hospitalizations in NYHA class I/II patients.
  • The therapy demonstrably improves ventricular structure and function in this patient population.
  • The REVERSE trial supports the use of CRT for earlier stages of systolic left ventricular dysfunction.
Abstract

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