title: Triple-site biventricular pacing in patients undergoing cardiac resynchronization therapy: a feasibility study.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  Twenty-six patients with New York Heart Association (NYHA) class III-IV, left ventricular ejection fraction (EF) < or = 35%, and QRS > or = 120 ms underwent triple-site CRT. Procedural course and complications were analysed. NYHA class, QRS duration, echocardiographic parameters, peak oxygen consumption (VO(2)max), 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, VO(2)max, 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 VO(2)max, 6MWD, EF, and improvement of indices of dyssynchrony were observed. Response rate in the studied group was 95.4%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: First Department of Cardiology, Silesian Center for Heart Disease, Silesian Medical School, ul Szpitalna 2, 41-800, Zabrze, Poland. elfizab@poczta.onet.pl
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Lenarczyk
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kukulski
authors.forename: Mariola
authors.initials: M
authors.lastname: Szulik
authors.forename: Patrycja
authors.initials: P
authors.lastname: Pruszkowska-Skrzep
authors.forename: Teresa
authors.initials: T
authors.lastname: Zielinska
authors.forename: Jacek
authors.initials: J
authors.lastname: Kowalczyk
authors.forename: Slawomir
authors.initials: S
authors.lastname: Pluta
authors.forename: Agata
authors.initials: A
authors.lastname: Duszanska
authors.forename: Beata
authors.initials: B
authors.lastname: Sredniawa
authors.forename: Agata
authors.initials: A
authors.lastname: Musialik-Lydka
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
mesh_terms: D000368:Aged; D001665:Binding Sites; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000473:pathology / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome