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Related Concept Videos

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Related Experiment Video

Updated: Apr 20, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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BLOCK HF: how far does it extend indications for cardiac resynchronization therapy?

Giuseppe Boriani1, Matteo Ziacchi, Igor Diemberger

  • 1aInstitute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy bCentre for Cardiovascular Sciences, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
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Summary

The BLOCK HF trial found cardiac resynchronization therapy (CRT) offered a modest benefit for heart failure patients with atrioventricular block. Further research is needed to clarify CRT

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • The Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) trial investigated cardiac resynchronization therapy (CRT) in patients with atrioventricular block and systolic dysfunction.
  • Previous CRT trials suggested significant benefits, but concerns regarding selection bias and trial validity were raised for the BLOCK HF study.
  • The study focused on patients with conventional pacing indications, left ventricular dysfunction, and New York Heart Association (NYHA) class I-III.

Purpose of the Study:

  • To determine if CRT is superior to conventional pacing in heart failure patients with atrioventricular block.
  • To evaluate the treatment effect and clinical utility of CRT in this specific patient population.
  • To assess the implications of the BLOCK HF trial findings for current clinical practice and recommendations.

Main Methods:

  • The BLOCK HF trial was an 8-year study comparing biventricular pacing (CRT) with right ventricular pacing.
  • Patient enrollment averaged two patients per center per year, raising concerns about potential selection bias.
  • The study assessed outcomes including death or hospitalization due to heart failure.

Main Results:

  • The BLOCK HF trial demonstrated a relatively low treatment effect for CRT compared to other CRT trials.
  • The absolute risk reduction for death or heart failure hospitalization was 4.8%, with a number needed to treat (NNT) of 21.
  • An estimated one-third of participants may have met current indications for CRT, suggesting potential under-enrollment of eligible patients.

Conclusions:

  • The BLOCK HF trial suggests a modest benefit of CRT in heart failure patients with atrioventricular block.
  • The study's findings raise uncertainties regarding the broad implementation of CRT and its cost-effectiveness due to unconsidered risks and costs.
  • Further evaluation is needed to clarify the role of CRT in current clinical guidelines and practice for this patient group.