title: Totally epicardial cardiac resynchronization therapy system implantation in patients with heart failure undergoing CABG.
abstract: BACKGROUND
  Systolic dyssynchrony is present in a considerable number of patients with heart failure (HF) undergoing coronary artery bypass grafting (CABG). Surgical revascularization offers an optimal setting for totally epicardial cardiac resynchronization therapy (CRT) system implantation.
  
  
  OBJECTIVE
  To assess the efficacy of totally epicardial CRT implantation during CABG, in patients with HF.
  
  
  METHODS
  Twenty three patients with HF and dyssynchrony underwent totally epicardial CRT system implantation during CABG. This randomised, single-blind, cross-over study compared clinical and echocardiographic parameters during two periods: 3 months of active CRT (CRT+) and 3 months of inactive CRT (CRT-) pacing.
  
  
  RESULTS
  Twenty two patients underwent randomisation and completed both study periods. In the CRT+ group more patients improved by two NYHA classes (p=0.028), had a longer 6-minute walk test distance (p=0.047) and better quality of life (p=0.003) compared with the CRT- group. Echocardiography revealed an improved LV ejection fraction (p<0.001), smaller LV end-systolic volume (p=0.04), reduced mitral regurgitation (p=0.026) and improved LV synchrony in the CRT+ group compared with the CRT- group.
  
  
  CONCLUSIONS
  CRT delivered by a totally epicardial system implanted during CABG is associated with additional improvement of clinical and echocardiographic parameters in patients with HF and systolic dyssynchrony.
authors.affiliation: Department of Electrocardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Kinga
authors.initials: K
authors.lastname: Goscinska-Bis
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Bis
authors.forename: Michal
authors.initials: M
authors.lastname: Krejca
authors.forename: Rafal
authors.initials: R
authors.lastname: Ulczok
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Szmagala
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bochenek
authors.forename: Wlodzimierz
authors.initials: W
authors.lastname: Kargul
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D018592:Cross-Over Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000628:therapy*