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Left ventricular versus simultaneous biventricular pacing in patients with heart failure and a QRS complex =120 milliseconds.
Circulation. 2011 Dec 20;124(25):2874-81
Publication Type
Bernard Thibault
Anique Ducharme
François Harel
Michel White
Eileen O'Meara
Marie-Claude Guertin
Joel Lavoie
Nancy Frasure-Smith
Marc Dubuc
Peter Guerra
Laurent Macle
Léna Rivard
Denis Roy
Mario Talajic
Paul Khairy
Author Affiliation
Montreal Heart Institute, 5000 Belanger St, Montreal, QC, Canada H1T 1C8.
Circulation. 2011 Dec 20;124(25):2874-81
Publication Type
Arrhythmias, Cardiac - diagnosis - physiopathology - therapy
Cardiac Resynchronization Therapy - methods
Cross-Over Studies
Double-Blind Method
Exercise Tolerance - physiology
Heart Failure - diagnosis - physiopathology - therapy
Heart Ventricles
Middle Aged
Quality of Life
Systole - physiology
Treatment Outcome
Ventricular Function, Left - physiology
Ventricular Function, Right - physiology
Left ventricular (LV) pacing alone may theoretically avoid deleterious effects of right ventricular pacing.
In a multicenter, double-blind, crossover trial, we compared the effects of LV and biventricular (BiV) pacing on exercise tolerance and LV remodeling in patients with an LV ejection fraction =35%, QRS =120 milliseconds, and symptoms of heart failure. A total of 211 patients were recruited from 11 centers. After a run-in period of 2 to 8 weeks, 121 qualifying patients were randomized to LV followed by BiV pacing or vice versa for consecutive 6-month periods. The greatest improvement in New York Heart Association class and 6-minute walk test occurred during the run-in phase before randomization. Exercise duration at 75% of peak Vo(2) (primary outcome) increased from 9.3±6.4 to 14.0±11.9 and 14.3±12.5 minutes with LV and BiV pacing, respectively, with no difference between groups (P=0.4327). LV ejection fraction improved from 24.4±6.3% to 31.9±10.8% and 30.9±9.8% with LV and BiV pacing, respectively, with no difference between groups (P=0.4530). Reductions in LV end-systolic volume were likewise similar (P=0.6788). The proportion of clinical responders (=20% increase in exercise duration) to LV and BiV pacing was 48.0% and 55.1% (P=0.1615). Positive remodeling responses (=15% reduction in LV end-systolic volume) were observed in 46.7% and 55.4% (P=0.0881). Overall, 30.6% of LV nonresponders improved with BiV and 17.1% of BiV nonresponders improved with LV pacing.
LV pacing is not superior to BiV pacing. However, nonresponders to BiV pacing may respond favorably to LV pacing, suggesting a potential role as tiered therapy.
URL: Unique identifier: NCT00901212.
Comment In: Circulation. 2012 Oct 9;126(15):e238; author reply e23923044613
Comment In: Circulation. 2011 Dec 20;124(25):2803-422184041
PubMed ID
22104549 View in PubMed
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