Recently published clinical guidelines recommend cardiac resynchronisation therapy ( CRT ) for patients with heart failure with reduced left ventricular ejection fraction ( LVEF ) and non-left bundle branch block ( non-LBBB ) QRS morphology.
Researchers sought to define the potential benefit of cardiac resynchronisation therapy in these patients through meta-analysis of randomised controlled trials ( RCTs ) that have reported outcomes in patients with non-LBBB QRS morphology.
Researchers performed a meta-analysis to assess the effect of cardiac resynchronisation therapy on the end points of death, heart failure hospitalisation, and the composite of death and heart failure hospitalisation.
Five RCTs were analysed, including 6523 participants ( 1766 with non-LBBB QRS morphology ).
Cardiac resynchronisation therapy was not associated with a reduction in death and/or heart failure hospitalisation in subjects with non-LBBB QRS morphology ( hazard ratio, HR=0.99; 95% CI 0.82 to 1.20 ).
In conclusion, cardiac resynchronisation therapy is not associated with a reduction in death or heart failure hospitalisation in patients with non-LBBB QRS morphology.
Wide QRS with non-LBBB morphology remains an area of uncertainty for cardiac resynchronisation therapy, which is included in the recent European Society of Cardiology ( ESC ) guidelines with a weaker strength of recommendation, but is not supported by a dedicated randomised controlled trial. ( Xagena )
Cunnington C et al, Heart 2015;101:1456-1462