Clinical Trial Shows Early CRT Improves Cardiac Function in Patients with Mild to Moderate Heart Failure, Slowing Disease Progression

BOSTON, MA, May 19, 2024 – This physician-initiated prospective, randomized clinical trial sponsored by The National Heart, Lung, and Blood Institute found that early cardiac resynchronization therapy (CRT) may slow the progression of heart failure in patients with mild to moderately reduced left ventricular ejection fraction (LVEF) and left bundle branch block (LBBB). Researchers presented these findings as late-breaking clinical science today at Heart Rhythm 2024.

Approximately 6.7 million adults in the U.S. have heart failure, and the prevalence is expected to rise to 8.5 million by 2030¹. Additionally, more than 30% of heart failure patients have conduction abnormalities. CRT, a pacemaker that corrects abnormal electrical conduction by simultaneously pacing the left and right heart chambers, is a well-established therapy for improving cardiac efficiency. According to the 2023 HRS guidelines on cardiac physiologic pacing, CRT can lead to improvement in survival time, decline in hospitalizations for heart failure, and stabilization of ventricular function.

To assess if CRT would improve or halt the progression of heart failure in patients with mild to moderately reduced LVEF and LBBB, Mayo Clinic researchers randomized clinical trial participants to receive either CRT-off (VVI RV pacing 40bpm) or CRT-on (DDDR BIV pacing 60-150bpm). After 6 months, the programming was reversed for another 6 months: patients who originally received CRT-off received CRT-on, and patients who originally received CRT-on received CRT-off. Patients who received CRT-off first experienced a significant reduction in left ventricular end-systolic volume (LVESV) only after the later CRT-on phase. Similarly, patients who received CRT-on first, followed by CRT-off, showed significant LVESV reduction in the initial CRT-on phase. Because LVESV remained lower than baseline even after the 12-month trial period, researchers concluded that the effects of CRT may persist for up to 6 months after CRT was turned off, indicating a CRT carry-over effect.

"In this study, we proposed use of CRT for patients to prevent the progression of mild to moderate heart failure," said Yong-Mei Cha, MD, cardiac electrophysiologist at Mayo Clinic, Rochester, Minnesota. "We confirmed early CRT improves cardiac systolic function in these patients, which supports HRS guidelines.

Looking ahead, the Mayo Clinic research team will investigate the long-term clinical outcomes of CRT in patients with mild to moderately reduced LVEF and LBBB, further advancing the understanding of this treatment option.

Session Details

"Late Breaking Clinical Trails and Science – CIEDs": "Early Cardiac Resynchronization Therapy for Patients with Moderately Reduced Ejection Fraction and Left Bundle Branch Block" [Sunday, May 19, 2024, at 9:30 am ET]

¹ Bozkurt B, Ahmad T, Alexander KM, Baker WL, Bosak K, Breathett K, Fonarow GC, Heidenreich P, Ho JE, Hsich E. Heart failure epidemiology and outcomes statistics: a report of the Heart Failure Society of America. Journal of cardiac failure. 2023 Oct;29(10):1412.
² Naqvi SY, Jawaid A, Goldenberg I, Kutyifa V. Non-response to cardiac resynchronization therapy. Current heart failure reports. 2018 Oct;15:315-21.

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