Targeted lead placement was no better than standard in resynchronisation therapy
Targeting a resynchronisation lead to the latest-activated site was no better than standard placement in patients with heart failure and left bundle branch block. Death or first unplanned heart failure admission occurred in 27.9 per cent of the targeted group and 25.5 per cent with standard placement. Jens Cosedis Nielsen said findings do not support routine electrical mapping. A tool estimates risk for each of four recommended heart-failure drug classes for one patient; only 2 per cent of eligible patients receive the full four-pillar treatment.
Science··Evening
Death or unplanned heart-failure admission was no lower with targeted leads
Patients with heart failure and left bundle branch block had a lead targeted to the latest-activated site or a standard placement across all five Danish university centres that implant resynchronisation devices. Death or a first unplanned heart failure admission occurred in 27.9 per cent of the targeted group and 25.5 per cent of the standard placement group. Jens Cosedis Nielsen of Aarhus University Hospital said the findings do not support routine electrical mapping to place the lead in current practice.[1]
Quality of life and capacity stayed similar; lead complications were more common
Secondary endpoints, including structural change in the left ventricle, quality of life, functional status and physical capacity, and the subgroup analyses stayed similar. Lead-related complications were numerically more common in the targeted group. Resynchronisation therapy goes with better symptoms, quality of life and survival in most patients, while up to a third get no benefit at all, and the team said the data would be analysed further to find which patients gain most.[1]
A calculator estimates each of four heart-failure drug classes for one patient
Nelson Wang's team at The George Institute for Global Health, with Brigham and Women's Hospital, built a tool that estimates risk for each of the four recommended drug classes for an individual patient. Only 2 per cent of eligible patients currently receive the full four-pillar treatment. About 64 million people live with heart failure worldwide, and one-year mortality risk reaches 30 per cent. Wang said clinicians hold off over fear of low blood pressure, worsening kidney function and high potassium. The tool was built from trial populations, and the team notes the estimates may not generalise fully to broader groups of patients.[2]
