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Right ventricular lead positioning does not influence the benefits of cardiac resynchronization therapy in patients with heart failure and atrial fibrillation.
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- Rönn, Folke (author)
- Umeå universitet,Kardiologi
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- Kesek, Milos (author)
- Umeå universitet,Kardiologi
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- Karp, Kjell (author)
- Umeå universitet,Klinisk fysiologi
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- (creator_code:org_t)
- 2011-06-28
- 2011
- English.
- In: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 13:12, s. 1747-1752
- Journal article (peer-reviewed)
Abstract
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- Aims Little is known about the optimal right ventricular (RV) pacing site in cardiac resynchronization therapy (CRT). This study compares bi-ventricular pacing at the left ventricular (LV) free wall combined with two different RV stimulation sites: RV outflow tract (RVOT+LV) vs. RV-apex (RVA+LV). Methods and results Thirty-three patients (32 males) with chronic heart failure, NYHA class III-IV, optimal drug therapy, QRS-duration ≥150 ms, and chronic atrial fibrillation (AF) received CRT with two different RV leads, in the apex (RVA) or outflow tract (RVOT), together with an LV lead, all connected to a bi-ventricular pacemaker. Randomization to pacing in RVOT+LV or RVA+LV was made 1 month after implantation and cross-over to the alternate pacing configuration occurred after 3 months. The median age of patients was 69 ± 10 years, the mean QRS was 179 ± 23 ms, and 58% of patients had ischaemic heart disease. Seven patients had pacemaker rhythm at inclusion and 60% were treated with atrioventricular-junctional ablation before randomization. In the RVA+LV and RVOT+LV pacing modes, 67 and 63% (nonsignificant) responded symptomatically with a decrease of at least 10 points in the Minnesota Living with Heart Failure score. The secondary end-points (6-min walk test, peak oxygen uptake, N-Terminal fragment of B-type Natriuretic Peptide, and left ventricular ejection fraction) showed significant improvement between baseline and CRT, but not between RVOT+LV and RVA+LV. Conclusion In this randomized controlled study, the exact RV pacing site, either apex or outflow tract, did not influence the benefits of CRT in a group of patients with chronic heart failure and AF. ClinicalTrials.gov ID: NCT00457834.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Congestive heart failure
- Cardiac resynchronization therapy
- Lead placement
- Atrial fibrillation
- Right ventricular pacing configurations
- Cardiac resynchronization
- Biventricular pacing
- Left ventricular pacing
- Right ventricular pacing
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- Rönn, Folke
- Kesek, Milos
- Karp, Kjell
- Henein, Michael
- Jensen, Steen M
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- MEDICAL AND HEALTH SCIENCES
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- Umeå University
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