A Randomized Comparison of Triple-Site Versus Dual-Site Ventricular Stimulation in Patients With Congestive Heart Failure

Leclercq, Christophe; Gadler, Fredrik; Kranig, Wolfgang; Ellery, Sue; Gras, Daniel; Lazarus, Arnaud; Clémenty, Jacques; Boulogne, Eric; Daubert, Jean‐Claude

doi:10.1016/j.jacc.2007.11.074

Cited by 196 publications

(112 citation statements)

References 24 publications

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“…For instance, in the BiV + intrinsic programming, the ventricles can be activated from 3 sites: 2 ventricular pacing sites localized in the left and right ventricles and the AVN (the sinus activation through AVN). Leclercq, et al 19) and Yoshida, et al 20) have reported that multi-site pacing demonstrates superior reverse remodeling of the left ventricle, together with increased LV dp/dt and cardiac output. Consistent with our findings in the present study, Vatasescu, et al showed a shorter LV activation time and a better CRT responder rate during bi-ventricular pacing with fusion, when compared to the results with conventional CRT.…”

Section: Discussionmentioning

confidence: 99%

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Guo

Zhang

et al. 2015

Int. Heart J.

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SummaryWe sought to evaluate the impact of biventricular (BiV) pacing with ventricular fusion by intrinsic atrioventricular nodal (AVN) conduction (BiV + intrinsic pacing) on clinical outcomes in patients with chronic heart failure (CHF) receiving cardiac resynchronization therapy (CRT).A total of 44 patients were randomized to receive either BiV or BiV + intrinsic pacing for one month. Echocardiographic optimization was performed for the BiV pacing mode, while the BiV + intrinsic pacing mode was achieved by titrating AV delay under electrocardiography (ECG) monitoring. Symptoms, quality of life, ECG, echocardiography, and cardiovascular events were recorded at baseline and the end of the follow-up for each pacing mode.Patients undergoing BiV + intrinsic pacing mode had shorter QRS duration compared to those with conventional BiV pacing (118.4 ± 21.6 ms versus 146.4 ± 5.3 ms, P < 0.0001). Also, these patients had improved echocardiographic left ventricular fractional shortening (LVFS) (17.4 ± 5.9 versus 15.7 ± 4.9, P = 0.019), higher left ventricular ejection fraction (LVEF) (35.5 ± 9.7 versus 32.7 ± 9.7, P = 0.048), longer 6-minute walk test (6MWT) (372.5 ± 80.9 m versus 328.7 ± 108.9 m, P = 0.0001), and better Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (12.5 ± 6.6 versus 18.2 ± 12.3, P = 0.0001).Treating CHF patients with BiV+intrinsic pacing resulted in improved cardiac function and quality of life. BiV + intrinsic pacing can be used in CHF patients with sinus rhythm and normal AV nodal conduction to improve CRT efficacy. (Int Heart J 2015; 56: 293-297) Key words: Intrinsic conduction, Heart failure, Electrocardiography, Echocardiography C ongestive heart failure (CHF) is a major public health problem associated with high mortality and morbidity. 1) Common causes of CHF include, but are not limited to ischemic heart disease, hypertension, arrhythmias, valvular diseases, cardiomyopathies, and congenital heart diseases.2,3) Cardiac resynchronization therapy (CRT), also known as biventricular pacing (BiV) or multisite ventricular pacing, simultaneously paces the right ventricle and the left ventricle. Large randomized clinical trials have shown that CRT improves symptoms, cardiac functions, and survival in patients with heart failure who have electrical dyssynchrony. CRT has been recommended by the American Heart Association (AHA) guidelines for patients with recurrent symptoms of systolic heart failure and a wide QRS complex, despite being on optimal medical therapy. [4][5][6][7][8] CRT allows for more efficient blood ejection by reducing mechanical inefficiency from dyssynchronous contraction. 3,9,10) However, there is a wide spectrum of clinical responses to CRT and one third of the patients who are selected for CRT fail to demonstrate any benefit from it.11,12) Therefore, the current clinical focus in CRT is to maximize the benefit from this therapy.A physiological approach to pacing is important for patients with CHF. It can be achieved by a number of methods including CRT, rate ada...

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Section: Discussionmentioning

confidence: 99%

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Guo

Zhang

et al. 2015

Int. Heart J.

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“…38 Another small trial demonstrated benefit of the triventricular strategy in patients with permanent atrial fibrillation. 39 These studies did not observe significant increases in procedural time, fluoroscopy exposure or complications associated with implantation of an additional LV lead. In 2012, Ginks et al examined LV endocardial and multi-site pacing in 10 patients with standard indications for CRT.…”

Section: Multi-site Left Ventricular Pacingmentioning

confidence: 74%

Developments in Cardiac Resynchronisation Therapy

Lewis

Gold

2015

Arrhythmia &Amp; Electrophysiology Review

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Since the introduction of CRT more than 20 years ago, its role in mild to severe systolic heart failure has become well established.CRT has been shown to decrease mortality, reduce heart failure hospitalisations and improve functional status in patients with NYHA class II-IV heart failure and QRS prolongation, most commonly with LBBB pattern.1 One of the major limitations of CRT implementation is the significant number of 'appropriate' candidates, as determined by guidelines, who fail to respond with clinical, functional or structural endpoints. The rate of non-responders has been estimated between 20 % and 40 %.2 Efforts to predict those patients who will respond to CRT and to optimise the magnitude of response have been important areas of focus with regard to the future of CRT. This article will present recent considerations and advances, both technical and theoretical, in CRT. 3 This trial examined 67 patients with LV ejection fraction (LVEF) ≤35 %, NYHA class III heart failure symptoms, sinus rhythm and QRS duration >150 ms who had biventricular pacemakers placed. The devices were initially programmed to ventricular back-up pacing for rates <40 beats per minute for a period of 3 months followed by reprogramming to encourage biventricular pacing. CRT resulted in significant improvement in 6-minute walk distance, quality of life and peak oxygen uptake as well as decreased hospitalisations. Eighty-five per cent of the study patients reported that they felt better during the period with biventricular pacing programmed on. BackgroundThe Multicentre InSync Randomised Clinical Evaluation (MIRACLE) trial evaluated a similar but much larger patient population. 4 There were 453 patients with NYHA class III-IV heart failure, LVEF ≤35 % and QRS duration ≥130 ms randomised to biventricular or no pacing. Over 6 months of follow-up, significant improvements were noted in 6-minute walk distance, NYHA class and quality of life. Additionally, CRT was an effective adjunct to optimal medical therapy in reducing the secondary combined endpoint of heart failure hospitalisation or death. Although the results of MUSTIC and MIRACLE were encouraging in terms of the clinical benefits of CRT, reduced mortality had not yet been proved. The Comparison of Medical Therapy, Pacing and Defibrillation(COMPANION) trial used a combined primary endpoint of hospitalisation or death from any cause.5 Enrolling 1,520 patients with LVEF ≤35 %, NYHA class III-IV heart failure and QRS duration >120 ms, this trial randomised subjects to optimal medical therapy, medical therapy with a CRT pacemaker (CRT-P) or medical therapy with a CRT defibrillator (CRT-D). At 1 year of follow-up, the CRT-D group showed significant reduction in overall mortality versus medical therapy alone, and the CRT-P group had showed a strong trend for reduced mortality (p=0.059).These results suggested a mortality benefit from CRT even in the absence of defibrillator capabilities.Several studies have since examined the effects of biventricular pacing alone (i.e. CRT-P) on heart fa...

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“…On the other hand, patients that show an increase in LVdP/ dt over 15% from an endocardial location are suitable candidates for an endocardial implant and the optimal site in the temporary study determines the target area for the permanent implant. Implantation of an additional CS lead, thus creating triple site ventricular stimulation in nonresponders is suggested by Leclercq et al, who demonstrated improvement in cardiac volumes by echocardiographic techniques in this configuration over biventricular stimulation (Leclercq et al, 2008). Although the effect and technique of triple ventricular stimulation needs further investigation (Auricchio & Prinzen, 2008), the technique is not feasible in the patient category with failed CS implants or short term failure of a single CS lead.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Endocardial Pacing Techniques as an Alternative for Ineffective Cardiac Resynchronization Therapy and the Role of Acute Hemodynamic Evaluation

Gelder¹,

Houthuizen²,

Scheffer³

et al. 2011

Modern Pacemakers - Present and Future

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A Randomized Comparison of Triple-Site Versus Dual-Site Ventricular Stimulation in Patients With Congestive Heart Failure

Abstract: Cardiac resynchronization therapy with 1 RV and 2 LV leads was safe and associated with significantly more LV reverse remodeling than conventional biventricular stimulation.

Cited by 196 publications

References 24 publications

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Developments in Cardiac Resynchronisation Therapy

Left Ventricular Endocardial Pacing Techniques as an Alternative for Ineffective Cardiac Resynchronization Therapy and the Role of Acute Hemodynamic Evaluation

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