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Updated: Jun 30, 2026

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

Zero-contrast cardiac resynchronization therapy device implantation in heart failure patients with renal impairment

Biagio Sassone1,2, Marco Zuin1,3,4, Angelo Melpignano5

  • 1Department of Translational Medicine, University of Ferrara, Ferrara, Italy.

Heart Rhythm O2
|June 29, 2026
PubMed

Insights

A zero-contrast approach for cardiac resynchronization therapy (CRT) is feasible and safe for patients with chronic kidney disease (CKD). This method preserves renal function better than traditional contrast-enhanced procedures.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Devices

Background:

  • Coronary sinus venography is standard for cardiac resynchronization therapy (CRT) lead placement.
  • Iodinated contrast used in venography risks contrast-induced acute kidney injury (AKI) in chronic kidney disease (CKD) patients.
  • Limited evidence exists for contrast-sparing CRT techniques.

Purpose of the Study:

  • To evaluate the feasibility, safety, and renal outcomes of a zero-contrast CRT implantation strategy.
  • To assess the impact on kidney function in patients with CKD.

Main Methods:

  • 113 CKD patients (eGFR <60 mL/min/1.73 m²) undergoing CRT were analyzed.
  • Procedures utilized a contrast-free approach, reserving venography as a bailout.
  • Multivariable logistic regression identified predictors of eGFR decline; secondary outcomes included LV ejection fraction improvement and mortality.

Main Results:

  • Zero-contrast implantation succeeded in 57.5% of cases.
  • Renal function stabilized in the zero-contrast group (+3.6 mL/min/1.73 m² eGFR change), unlike the contrast group (-7.9 mL/min/1.73 m²).
  • Postprocedural AKI was significantly lower in the zero-contrast group (1.5% vs. 14.6%).

Conclusions:

  • Zero-contrast CRT implantation is a feasible, safe, and effective strategy for CKD patients.
  • This approach offers superior renal preservation compared to contrast-based methods.
  • Contrast use, lower baseline eGFR, and diabetes independently predicted significant eGFR decline.
Abstract

Keywords:
Cardiac resynchronization therapyChronic kidney diseaseContrast-induced nephropathyDeathHeart failure hospitalizationLeft ventricular lead

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