Related Experiment Video

Updated: Aug 6, 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

Two-Lead Versus Conventional Three-Lead Cardiac Resynchronization Therapy in Heart Failure With Reduced Ejection

Sammy Dawoud1, Hany Dawoud1, Aakash Hans2

  • 1From the Department of Medicine, International University of the Health Sciences, Basseterre, St. Kitts and Nevis.

Cardiology in Review
|July 21, 2026
PubMed

Insights

Two-lead cardiac resynchronization therapy (CRT) offers similar outcomes to traditional 3-lead systems but with fewer complications. This lead-sparing approach is effective for selected heart failure patients.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • Cardiac resynchronization therapy (CRT) is vital for heart failure (HF) with reduced ejection fraction.
  • Conventional CRT-defibrillator (CRT-D) systems use 3 transvenous leads, increasing complication risks.
  • Two-lead CRT systems present a less invasive alternative for specific patient groups.

Purpose of the Study:

  • To compare the efficacy and safety of two-lead CRT (CRT-DX or single-pass Ventricular Dual-Dual CRT) versus conventional 3-lead CRT-D.
  • To evaluate outcomes including mortality, complications, and echocardiographic response.
  • To assess the feasibility of lead-sparing strategies in CRT.

Main Methods:

  • Systematic literature search of PubMed, Embase, and Cochrane CENTRAL up to May 2026.
  • Inclusion of randomized and observational studies comparing two-lead CRT with 3-lead CRT-D in adults.
  • Analysis of primary outcomes: all-cause mortality, atrial lead complications, major complications, HF hospitalization. Secondary outcomes included echocardiographic measures and procedure time.

Main Results:

  • Two-lead CRT significantly reduced atrial lead complications (OR 0.31) and major complications (OR 0.45) compared to 3-lead CRT-D.
  • Procedure time was notably shorter with two-lead CRT (MD -13.11 minutes).
  • No significant differences were found in all-cause mortality, HF hospitalization, or echocardiographic response between the groups.

Conclusions:

  • Two-lead CRT-DX provides comparable clinical and echocardiographic outcomes to 3-lead CRT-D in selected patients without an atrial pacing indication.
  • This approach reduces lead-related complications and procedure time, supporting lead-sparing strategies.
  • Larger randomized trials with extended follow-up are warranted to confirm these findings.

Keywords:
2-lead CRTCRT-DXCRT-defibrillator (CRT-D)cardiac resynchronization therapy (CRT)heart failure with reduced ejection fraction (HFrEF)lead-related complicationsmeta-analysissingle-pass VDD lead

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