Skip header and navigation

Refine By

3 records – page 1 of 1.

Left ventricular versus simultaneous biventricular pacing in patients with heart failure and a QRS complex =120 milliseconds.

https://arctichealth.org/en/permalink/ahliterature129479
Source
Circulation. 2011 Dec 20;124(25):2874-81
Publication Type
Article
Date
Dec-20-2011
Author
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. ablation2000@bellnet.ca.
Source
Circulation. 2011 Dec 20;124(25):2874-81
Date
Dec-20-2011
Language
English
Publication Type
Article
Keywords
Aged
Arrhythmias, Cardiac - diagnosis - physiopathology - therapy
Canada
Cardiac Resynchronization Therapy - methods
Cross-Over Studies
Double-Blind Method
Electrocardiography
Exercise Tolerance - physiology
Female
Heart Failure - diagnosis - physiopathology - therapy
Heart Ventricles
Humans
Male
Middle Aged
Quality of Life
Systole - physiology
Treatment Outcome
Ventricular Function, Left - physiology
Ventricular Function, Right - physiology
Abstract
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: http://www.clinicaltrials.gov. Unique identifier: NCT00901212.
Notes
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
Less detail