Targeted left ventricular lead placement in biventricular pacing for heart failure: a national, multicentre, double-blind, randomised controlled trial in Denmark.
Jens Cosedis Nielsen, Jesper Hastrup Svendsen, Jens Brock Johansen et al.
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In 30 seconds
This multicentre, double-blind, randomised controlled trial evaluated the impact of targeted left ventricular lead placement at the site of latest electrical activation on heart failure outcomes in 1000 patients. The primary outcome, a composite of time to death or first unplanned heart failure hospitalisation, occurred in 28% of the intervention group and 26% of the control group, yielding a hazard ratio of 1.10 (95% CI 0.86-1.39; p=0.45).
Key findings
- The primary endpoint occurred in 139 (28%) of the intervention group and 128 (26%) of the control group.
- The mean electrical activation at the left ventricular lead was 9 milliseconds later in the intervention group.
- Overall complication risk was similar: 14% in the intervention group vs 13% in the control group.
- One procedure-related death occurred in the intervention group.
Why it matters
The study highlights that targeting left ventricular lead placement based on electrical activation does not improve critical outcomes in heart failure patients, suggesting that conventional lead placement may be equally effective.