No difference in lead implantation approaches for CRT in non-LBBB patients
Although previous data suggest that cardiac resynchronization therapy works well in left bundle branch block patients, CRT has not been as effective in non-LBBB patients.
In a 248-patient trial sponsored by Abbott, researchers sought to compare outcomes between two different lead implantation approaches in non-LBBB patients undergoing CRT.
Lead author Dr. Jagmeet Singh of the Mass. General Hospital noted that prior work indicated that left ventricular lead implantation over an area of increased electrical delay – the QLV approach – may boost a patient’s response. In Abbott’s Enhance CRT trial, researchers hoped to better understand whether targeted LV lead placement can improve CRT in non-LBBB patients.
“This is the first study to ever look at patients selectively in the non-left bundled branch block population,” Singh noted.
The primary endpoint was measured by a clinical composite score at 12 months. Although non-LBBB patients had significant clinical response to CRT, there was no difference in clinical outcomes for the QLV-based approach and the standard, anatomical implant approach.
Despite that, Singh and others at the conference pointed out that the trial pushed back against previous data suggesting that non-LBBB patients do not respond to CRT.
“It was a very positive study,” said Dr. Michael Gold of the Medical University of South Carolina. “It’s shown that CRT is an effective therapy in patients with non-left bundle branch block.”