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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

Cardiac resynchronization therapy in patients with minimal heart failure: a systematic review and meta-analysis

Selcuk Adabag1, Henri Roukoz, Inder S Anand

  • 1Division of Cardiology, Veterans Administration Medical Center, and University of Minnesota, Minneapolis, Minnesota, USA. adaba001@umn.edu

Journal of the American College of Cardiology
|August 20, 2011
PubMed

Insights

Cardiac resynchronization therapy (CRT) significantly reduces mortality and hospitalizations in heart failure (HF) patients with reduced ejection fraction. While beneficial for NYHA class I/II HF, careful risk-benefit assessment is needed for asymptomatic patients.

Area of Science:

  • Cardiology
  • Heart Failure Management
  • Medical Device Therapy

Background:

  • Heart failure (HF) is a significant cause of morbidity and mortality.
  • Cardiac resynchronization therapy (CRT) has demonstrated benefits in advanced HF.
  • Emerging evidence suggests CRT may also benefit patients with milder HF symptoms.

Purpose of the Study:

  • To systematically review and meta-analyze randomized clinical trials comparing CRT and implantable cardioverter-defibrillators (ICDs).
  • To evaluate the efficacy of CRT versus ICD in patients with reduced ejection fraction, prolonged QRS interval, and NYHA class I-II HF.

Main Methods:

  • Meta-analysis of 5 prospective randomized clinical trials.
  • Inclusion of 4,317 patients with NYHA functional class I/II heart failure.
  • Comparison of outcomes between CRT and ICD groups.

Main Results:

  • CRT significantly reduced all-cause mortality (8% vs. 11.5%) and HF hospitalizations (11.6% vs. 18.2%) compared to ICD.
  • CRT led to greater improvements in left ventricular ejection fraction (LVEF) and LV volume.
  • In NYHA class II patients, CRT significantly lowered mortality and HF hospitalizations.
  • In NYHA class I patients, CRT reduced HF hospitalization risk but not mortality.

Conclusions:

  • CRT is effective in decreasing all-cause mortality, reducing HF hospitalizations, and improving LVEF in NYHA class I-II HF patients.
  • The benefits of CRT in asymptomatic (NYHA class I) HF patients, particularly regarding hospitalization reduction, warrant careful consideration of risks versus benefits.
Abstract

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