Targeted lead placement is no better than standard placement in cardiac resynchronization therapy
Targeted placement of the left ventricular lead did not improve outcomes in patients with heart failure undergoing cardiac resynchronization therapy, according to results presented in a Hot Line session at ESC Congress 2026 and published simultaneously in The Lancet.
A Danish study published in The Lancelast month found that targeting the placement of the left ventricular lead in cardiac resynchronization therapy (CRT) does not improve outcomes for heart failure patients with left bundle branch block. The DANISH-CRT trial, a large double-blind randomized controlled trial involving 1,000 patients at five Danish university centers, showed no difference in death or first heart-failure hospitalization between patients with targeted lead placement and those with standard placement over a median follow-up period of 45.8 months.
Secondary outcomes such as structural changes to the left ventricle, quality of life, functional status, and physical capacity also remained unchanged. While the targeted placement group experienced slightly more lead-related complications, the researchers conclude that routinely electrically mapping the left ventricular lead is not necessary in contemporary CRT practice.
The investigators plan to further analyze the data to identify patient subgroups that may benefit most from CRT.
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