Journal Article

Triple-site biventricular pacing in patients undergoing cardiac resynchronization therapy: a feasibility study

Radosław Lenarczyk, Oskar Kowalski, Tomasz Kukulski, Mariola Szulik, Patrycja Pruszkowska-Skrzep, Teresa Zielińska, Jacek Kowalczyk, Sławomir Pluta, Agata Duszańska, Beata Średniawa, Agata Musialik-Łydka and Zbigniew Kalarus

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 9, pages 762-767
Published in print September 2007 | ISSN: 1099-5129
Published online July 2007 | e-ISSN: 1532-2092 | DOI:
Triple-site biventricular pacing in patients undergoing cardiac resynchronization therapy: a feasibility study

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Aims To evaluate implantation safety and efficiency of triple-site (double left–single right) cardiac resynchronization therapy (CRT) and to assess the outcome of this procedure.

Methods and results Twenty-six patients with New York Heart Association (NYHA) class III–IV, left ventricular ejection fraction (EF) ≤ 35%, and QRS ≥ 120 ms underwent triple-site CRT. Procedural course and complications were analysed. NYHA class, QRS duration, echocardiographic parameters, peak oxygen consumption (VO2max), and 6 min walking distance (6MWD) were assessed at baseline and after 3 months. Responders were defined by survival, by no re-hospitalization for heart failure, and by >10% EF, VO2max, and 6MWD increase. Implantation was successful in 22 patients (84.6%). Procedure duration (199.1 min) and fluoroscopy time (38.7 min) were higher than in standard procedures. Two clinically silent coronary sinus dissections occurred intra-operatively; one phrenic nerve stimulation and one pocket infection were observed during follow-up. After 3 months of CRT, a significant reduction (P < 0.05) of NYHA class, increment of VO2max, 6MWD, EF, and improvement of indices of dyssynchrony were observed. Response rate in the studied group was 95.4%.

Conclusion Triple-site resynchronization appears to be a safe and efficient treatment method, with high response rate. Further studies are needed to evaluate the role of this pacing mode in CRT.

Keywords: Heart failure; Multisite pacing; Resynchronization therapy; Non-invasive assessment; Echocardiography

Journal Article.  3641 words.  Illustrated.

Subjects: Cardiovascular Medicine

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