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

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

doi:10.1093/europace/eum140

Cited by 50 publications

(29 citation statements)

References 21 publications

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“…Until very recently, the only data on triple-site biventricular pacing came from anecdotal case-reports, which suggested that this type of stimulation can improve clinical status and suppress ventricular arrhythmias in HF patients [12][13][14]. In our previous study we demonstrated that dual left-single right cardiac resynchronization is a safe method and can be performed successfully in the majority of CRT candidates [7]. Furthermore, we showed that this type of pacing is highly effective in improving clinical status and echocardiographic parameters in HF patients.…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, any technique which could increase the response rate of resynchronization would be crucial for CRT candidates. Triple-site pacing has been recently proposed as a safe and efficient method of resynchronization [7]. The primary purpose of our study was to compare the safety, procedural course of the implantation procedures and left ventricular leads' performance in the HF patients undergoing triple-site and conventional resynchronization.…”

Section: Introductionmentioning

confidence: 99%

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Mid-term outcomes of triple-site vs. conventional cardiac resynchronization therapy: A preliminary study

Lenarczyk

Kowalski

Kukulski

et al. 2009

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Mid-term outcomes of triple-site vs. conventional cardiac resynchronization therapy: A preliminary study

Lenarczyk

Kowalski

Kukulski

et al. 2009

International Journal of Cardiology

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“…Today, the triventricular approach in clinical practice involves implanting two LV leads as far apart as possible (2,16). Success rates of ϳ85% have been reported using available tools (16).…”

Section: Comparison Of Triventricular Pacing Vs Epicardial and Endocmentioning

confidence: 99%

“…Success rates of ϳ85% have been reported using available tools (16). The complicated implant, coupled with the lack of tools to determine the optimal sites and longevity concerns with multiple LV pacing outputs makes this approach difficult to implement in routine clinical practice.…”

Section: Comparison Of Triventricular Pacing Vs Epicardial and Endocmentioning

confidence: 99%

Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart failure

Bordachar

Grenz

Jaı̈s

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but ~30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial and multisite epicardial [triventricular (TriV)] pacing have been proposed as alternatives to traditional LV transvenous epicardial pacing, but no study has directly compared the hemodynamic effects of these approaches. Left bundle branch block ablation and repeated microembolizations were performed in dogs to induce electrical dysynchrony and to reduce LV ejection fraction to <35%. LVdP/dt(max) and other hemodynamic indexes were measured with a conductance catheter during LV epicardial, LV endocardial, biventricular (BiV) epicardial, BiV endocardial, and TriV pacing performed at three atrioventricular delays. LV endocardial pacing was obtained with a clinically available pacing system. The optimal site was defined as the site that increased dP/dt(max) by the largest percentage. Implantation of the endocardial lead was feasible in all canines (n = 8) without increased mitral regurgitation seen with transesophageal echocardiography and with full access to the different LV endocardial pacing sites. BiV endocardial pacing increased dP/dt(max) more than BiV epicardial and TriV pacing on average (P < 0.01) and at the optimal site (P < 0.01). There were no significant differences between BiV epicardial and TriV pacing. BiV endocardial pacing was superior to BiV epicardial and to TriV pacing in terms of acute hemodynamic response. Further investigation is needed to confirm the chronic benefit of this approach in humans.

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“…A common way to achieve TRIV pacing is to implant the pacing leads at the RV apex, the RVOT, and the LV through the coronary sinus. In a recent study, 37 this technique was performed in 26 patients, and after 3 months, a significant reduction (P < .05) of NYHA class, improvement of exercise capacity, and increased EF were observed. In a preliminary study recently published, 38 54 heart failure patients were enrolled and randomly assigned to either BiV or TRIV mode of pacing.…”

Section: Triventricular Pacingmentioning

confidence: 94%

Alternate Site Pacing in Patients at Risk for Heart Failure

2008

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Cardiac pacing from the right ventricular apex is the most common site of cardiac pacing. During the last decade, several studies demonstrated the harmful effects of the iatrogenic left bundle branch block, which is observed in cardiac pacing from the right ven- tricular apex. These observations led to an interest in alternative right ventricular pacing sites aiming to achieve a more “physiological” pattern of ventricular activation. Alternate site pacing may involve His bun- dle, other right ventricular sites (outflow or septal sites), or left ventricular sites in either unifocal or bifo- cal or biventricular modes. Pacing from the right ven- tricular outflow tract has been studied extensively. Several studies showed that right ventricular outflow tract pacing has better hemodynamic effects and less harmful influence. Bifocal right ventricular (apical and outflow tract) pacing has been proposed for patients with heart failure where the coronary sinus approach to effect biventricular pacing turns out to be unsuccessful because of various reasons. Some studies examined left ventricular pacing alone as an alternative mode of pacing, and the results were quite encouraging but not conclusive. Finally, in heart failure patients not responding to biventricular pacing, the triple site pacing mode has been recently proposed. In triple site pacing, the leads are inserted in the right ventricular apex and outflow tract in conjunction with lateral left ventricular pacing. Improvement of exercise capacity and increased ejection fraction were observed with this triventricular pacing. Although more data from specifically designed randomized studies are needed, there are many alternative pacing sites, especially for patients at high risk of heart failure, which seems to be less harmful and better tolerated by the patients.

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

Abstract: 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.

Cited by 50 publications

References 21 publications

Mid-term outcomes of triple-site vs. conventional cardiac resynchronization therapy: A preliminary study

Mid-term outcomes of triple-site vs. conventional cardiac resynchronization therapy: A preliminary study

Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart failure

Alternate Site Pacing in Patients at Risk for Heart Failure

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