DANISH-CRT

doi:10.1016/s0140-6736(26)01597-7

DANISH-CRT — Does Targeted LV Lead Positioning Towards Latest Local Electric Activation at CRT Implantation Reduce Incidence of the Combined Endpoint "Death or Non-planned Hospitalisation for Heart Failure" in Patients With HF and Prolonged QRS

Patient / Population Intervention / Exposure Comparison Outcome

In 1,000 patients with heart failure and bundle branch block receiving CRT, electrically targeted LV lead placement did not reduce death or unplanned heart-failure hospitalisation compared with conventional lead placement.

N

1,000patients

Design

Danish national multicentre (all five Danish university implanting centres), double-blind (patients and all study personnel except operating-room personnel masked), randomised 1:1 by block randomisation; CRT with the LV lead targeted by intra-procedural electrical mapping to the coronary-sinus branch with the latest local electrical activation versus conventional placement in a posterolateral, non-apical branch; superiority design, event-driven with minimum 2-year follow-up; modified intention-to-treat analysis, safety in all correctly assigned patients; enrolment 20 March 2018 to 3 June 2024, follow-up completed 27 February 2026; NCT03280862; sponsor Aarhus University Hospital.

Endpoint

Time to death or first non-planned hospitalisation for heart failure

Relevance

1Practice-defining — the trial the guideline rests on.

ResultDeath or first unplanned heart-failure hospitalisation occurred in 27.9% with targeted placement and 25.5% with conventional placement over a median 45.8 months (HR 1.10, 95% CI 0.86–1.39; P = 0.45). Lead-related complications were more frequent in the targeted group.

Nielsen JC, et al. Lancet. 2026; published online 31 August. Presented at ESC Congress 2026, Hot Line 10. 10.1016/s0140-6736(26)01597-7

Discussion & critique

Mapping the latest-activated segment and putting the lead there is the physiological argument for CRT made literal, and over nearly four years it bought nothing — the same events, a numerically worse hazard, and more lead complications for the trouble. Either the electrical target is not where the mechanical benefit lives, or conventional posterolateral placement already lands close enough often enough that a mapping step has no room to add. Blinded, event-driven and 1,000 patients: this is as clean a negative as CRT procedure trials get, and the investigators' conclusion against routine mapping should hold.