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Lack of response to cardiac resynchronization therapy (CRT) remains a clinical challenge and is predominantly attributed to suboptimal LV lead positioning. Multisite pacing (MS-CRT) has emerged as an alternative to biventricular pacing, however clinical responses have not been thoroughly investigated.
66 patients (45 males) with CHF (NYHA Ill and ambulatory llll) underwent initial MS-CRT (ICRT, n=49) or upgrade to MS-CRT from standard CRT after worsening of clinical status or adverse remodeling (UCRT, n=17). Major adverse clinical events (MACE) were death, heart failure (HF) hospitalization and cardiac transplantation or ventricular assist device implant at one year.
Clinical characteristics and baseline LVEF, were similar between groups except for AF (64.7% vs 33.3% for the UCRT and ICRT groups, p=0.025) and history of ventricular arrhythmias (41.3% vs 16.7% for the UCRT and ICRT groups, p=0.039). Mean LVEF change after implant was not different between the ICRT and UCRT groups (8.0±8% vs 4.1±6.3%, p=0.27). At one year, the probability for MACE was similar between the two groups (LR=0.892). Time to first HF hospitalization was not different between groups (222.3±134d vs 267.2±118d for the ICRT and UCRT groups, p=0.818).
Upgrade to MS-CRT in CRT non-responders results in clinical response similar to the observed response with initial MS-CRT implant. Multisite pacing may be useful in CRT non responders.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure: Cardiac Resynchronization Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1177-311
- 2013 American College of Cardiology Foundation