Triple-site biventricular pacing in patients undergoing cardiac resynchronization therapy: a feasibility study.
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.
Lenarczyk
Radoslaw
R
First Department of Cardiology, Silesian Center for Heart Disease, Silesian Medical School, ul Szpitalna 2, 41-800, Zabrze, Poland. elfizab@poczta.onet.pl
Kowalski
Oskar
O
Kukulski
Tomasz
T
Szulik
Mariola
M
Pruszkowska-Skrzep
Patrycja
P
Zielinska
Teresa
T
Kowalczyk
Jacek
J
Pluta
Slawomir
S
Duszanska
Agata
A
Sredniawa
Beata
B
Musialik-Lydka
Agata
A
Kalarus
Zbigniew
Z
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