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A randomized comparison of triple-site versus dual-site ventricular stimulation in patients with congestive heart failure.

Abstract：

OBJECTIVES:We compared the effects of triple-site versus dual-site biventricular stimulation in candidates for cardiac resynchronization therapy. BACKGROUND:Conventional biventricular stimulation with a single right ventricular (RV) and a single left ventricular (LV) lead is associated with persistence of cardiac dyssynchrony in up to 30% of patients. METHODS:This multicenter, single-blind, crossover study enrolled 40 patients (mean age 70 +/- 9 years) with moderate-to-severe heart failure despite optimal drug treatment, a mean LV ejection fraction of 26 +/- 11%, and permanent atrial fibrillation requiring cardiac pacing for slow ventricular rate. A cardiac resynchronization therapy device connected to 1 RV and 2 LV leads, inserted in 2 separate coronary sinus tributaries, was successfully implanted in 34 patients. After 3 months of biventricular stimulation, the patients were randomly assigned to stimulation for 3 months with either 1 RV and 2 LV leads (3-V) or to conventional stimulation with 1 RV and 1 LV lead (2-V), then crossed over for 3 months to the alternate configuration. The primary study end point was quality of ventricular resynchronization (Z ratio). Secondary end points included reverse LV remodeling, quality of life, distance covered during 6-min hall walk, and procedure-related morbidity and mortality. Data from the 6- and 9-month visits were combined to compare end points associated with 2-V versus 3-V. RESULTS:Data eligible for protocol-defined analyses were available in 26 patients. No significant difference in Z ratio, quality of life, and 6-min hall walk was observed between 2-V and 3-V. However, a significantly higher LV ejection fraction (27 +/- 11% vs. 35 +/- 11%; p = 0.001) and smaller LV end-systolic volume (157 +/- 69 cm(3) vs. 134 +/- 75 cm(3); p = 0.02) and diameter (57 +/- 12 mm vs. 54 +/- 10 mm; p = 0.02) were observed with 3-V than with 2-V. There was a single minor procedure-related complication. CONCLUSIONS:Cardiac resynchronization therapy with 1 RV and 2 LV leads was safe and associated with significantly more LV reverse remodeling than conventional biventricular stimulation.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Leclercq C,Gadler F,Kranig W,Ellery S,Gras D,Lazarus A,Clémenty J,Boulogne E,Daubert JC,TRIP-HF (Triple Resynchronization In Paced Heart Failure Patients) Study Group.

doi

10.1016/j.jacc.2007.11.074

subject

Has Abstract

pub_date

2008-04-15 00:00:00

pages

1455-62

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(08)00390-2

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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A randomized comparison of triple-site versus dual-site ventricular stimulation in patients with congestive heart failure.