Outcomes in targeted LV lead implantation vs. anatomical approach similar at 12 months
Among patients needing left ventricular lead implantation, those who underwent an approach based on increased electrical delay in the LV region had similar 12-month outcomes as those who had anatomical implantation, researchers reported.
Findings from the ENHANCE CRT study, published in JACC: Clinical Electrophysiology, showed that patients with non-left bundle branch block who underwent LV lead implantation with an increased electrical delay in the LV region (QLV)-based approach experienced similar cardiac resynchronization therapy (CRT) response rates, freedom from HF hospitalization and CV death and similar quality of life improvements as those who underwent anatomical implantation.
“Clinical improvement as evidenced by the clinical composite score and favorable reverse remodeling was observed at similar rates in both arms,” Cardiology Today Editorial Board Member Jagmeet P. Singh, MD, DPhil, professor of medicine at Harvard Medical School and founding director of the Resynchronization and Advanced Cardiac Therapeutics program at Massachusetts General Hospital, and colleagues wrote. “In addition, there was no difference in the clinical outcomes of patients between the QLV-based implantation approach and the conventional anatomical implantation approach.”
For this study, researchers assessed 191 patients at 12-month follow-up, of whom 128 underwent a QLV-based approach for LV lead implantation and 63 underwent anatomical implantation. The primary endpoint was a clinical composite score that consisted of NYHA functional class, a patient global assessment, HF events and CV death.
Patients were considered CRT responders if they showed improvement by at least one NYHA functional class or improved in the patient global assessment and experienced no HF events and no CV death.
Both groups demonstrated similar CRT response rates as measured by the clinical composite score at 12 months (67.2% for QLV group vs. 73% for control group; P = .506), according to the study.
Freedom from HF hospitalization and CV death was also similar between the QLV group and the control group at 6- and 12-month follow-up (P = .98).
Patients in both groups experienced similar improvements in Minnesota Living With Heart Failure scores, with the QLV group improving from a mean score of 53.5 at baseline to 34.9 at 6 months and the control group going from 55.1 at baseline to 35.7 at 6 months, the researchers reported.
“Patients with non-left bundle branch block respond well to CRT, with no difference between a QLV and an anatomical LV lead implantation approach,” they wrote. “Further studies are needed to additionally parse the clinical impact of resynchronization therapy and LV lead implantation within different forms of non-left bundle branch block.”