Henrik Laurits Bjerre

Introduction: Patients with heart failure induced by chronic right ventricular (RV) pacing commonly undergo upgrade to cardiac resynchronization therapy (CRT). We aimed to compare the effect size of improvement in cardiac function and functional capacity between patients with RV pacing and intrinsic conduction at baseline. Methods: We included patients from the ImagingCRT, ElectroCRT and DANISH-CRT trials aged ≥40 years with left ventricular ejection fraction (LVEF) ≤35% and prolonged QRS. The primary endpoint was change in left ventricular end-systolic volume (LVESV) from baseline to 6-month follow-up. Secondary endpoints included change in QRS duration, echocardiographic measures (LVEF, left ventricular end-diastolic volume, left ventricular mass index, and left atrial volume index), N-terminal prohormone of brain natriuretic peptide, six-minute walk test, quality of life, New York Heart Association functional class and loop diuretic use. Results: We included 592 patients [mean age 70.7 ± 9 years; 24.8% women; mean LVEF 27 ± 6%; 97 (16.4%) with RV pacing and 495 (83.6%) with intrinsic conduction at baseline]. We found significant relative reduction in LVESV in patients with RV pacing (−34 ± 25%) and intrinsic conduction (−32 ± 26%) with no difference between the groups [mean difference −2%, 95% CI (−8; 4), P = .469]. Absolute LVEF improvement was 14 ± 9% and 13 ± 10%, respectively. Reduction in QRS duration was larger with RV pacing compared with intrinsic conduction (−38 ± 26 vs −26 ± 24 ms). We found significant improvements in the remaining secondary endpoints, with no difference between the groups. Conclusion: Patients with RV paced QRS morphology who are upgraded to CRT derive substantial improvement in cardiac function and functional capacity, comparable to patients with intrinsic conduction undergoing CRT.

Purpose: Labor market participation is an important rehabilitation goal for working-age patients living with heart failure (HF). Cardiac resynchronization therapy (CRT) reduces mortality and HF hospitalizations and improves quality of life, but no studies have investigated labor market participation following CRT. We therefore aimed to describe labor market participation in patients with HF before and after CRT implantation. Methods: This region-wide register-based cohort study comprised patients with HF aged 40 to 63 yr, with ejection fraction ≤35% and QRS duration >130 milliseconds, who received a CRT system from 2000 to 2017 in the Central Denmark Region. Using unambiguous, individual-level linkage in Danish medical and administrative registries, we assessed weekly employment status from 1 yr prior to CRT implantation until 2 to 5 yr of follow-up and conducted stratified analyses by sociodemographic and disease-related risk factors. Results: We identified 546 patients, of whom 42% were in early retirement 1 yr prior to implantation. Active employment decreased from 45% to 19% from 1 yr before until implantation, declining primarily in the last 8 wk before implantation. The proportion of patients in active employment increased in the first 8 wk after CRT implantation and then stabilized, reaching 31% at 1-yr follow-up. We observed lower labor market participation in patients with older age, multimorbidity, lower educational level, and upgrade procedures, but higher in later calendar year. Conclusions: In working-age patients with HF, labor market participation increased after CRT implantation, despite many patients being retired prior to implantation. We observed differences in active employment related to several sociodemographic and disease-related factors.

Several studies have evaluated the use of electrically- or imaging-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) recipients. We aimed to assess evidence for a guided strategy that targets LV lead position to the site of latest LV activation. A systematic review and meta-analysis was performed for randomized controlled trials (RCTs) until March 2023 that evaluated electrically- or imaging-guided LV lead positioning on clinical and echocardiographic outcomes. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization, and secondary endpoints were quality of life, 6-min walk test (6MWT), QRS duration, LV end-systolic volume, and LV ejection fraction. We included eight RCTs that comprised 1323 patients. Six RCTs compared guided strategy (n = 638) to routine (n = 468), and two RCTs compared different guiding strategies head-to-head: electrically- (n = 111) vs. imaging-guided (n = 106). Compared to routine, a guided strategy did not significantly reduce the risk of the primary endpoint after 12–24 (RR 0.83, 95% CI 0.52–1.33) months. A guided strategy was associated with slight improvement in 6MWT distance after 6 months of follow-up of absolute 18 (95% CI 6–30) m between groups, but not in remaining secondary endpoints. None of the secondary endpoints differed between the guided strategies. In this study, a CRT implantation strategy that targets the latest LV activation did not improve survival or reduce heart failure hospitalizations.