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Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure: A meta-analysis of randomized and observational studies.

ABSTRACT: Background:Conventional cardiac resynchronization therapy (CRT, Bi-V) is associated with no response in about 40% patients due to an insufficient resynchronization. Some studies showed triple-site ventricular (Tri-V) pacing had greater benefits compared with Bi-V pacing, but the results of these studies were conflicting. We hypothesized that Tri-V pacing had greater benefits on long-term outcomes compared with Bi-V pacing in patients with heart failure. Methods:PubMed, EMBASE, and the Cochrane Library were searched for clinical studies with related outcomes. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated to compare the change in left ventricular ejection fraction (LVEF), left ventricular geometry, functional capacity, and quality of life between Tri-V pacing group and control group. Results:Five trials with 251 patients were included in the analysis. Patients in the Tri-V pacing group had a greater improvement in LVEF (WMD 4.04; 95% CI 2.15-5.92, P < .001) and NYHA classes (WMD -0.27; 95% CI -0.42 to -0.11, P = .001) compared with control group. However, there were no significant differences in left ventricular geometry, six-min walk distance, or Minnesota Living With Heart Failure Questionnaire score between the two groups. The subgroup analyses showed there might be a greater improvement in LVEF in the Tri-V pacing group in patients with QRS duration ? 155 ms (WMD 5.60; 95% CI 3.09-8.10, P < .001). Conclusions:The present analysis suggests that Tri-V pacing has greater benefits in terms of an improvement in LVEF and functional capacity in patients with systolic heart failure, especially in patients with the duration of QRS ? 155 ms.

SUBMITTER: Zhang B

PROVIDER: S-EPMC5828262 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure: A meta-analysis of randomized and observational studies.

Zhang Baowei B Guo Junfang J Zhang Guohui G

Journal of arrhythmia 20171221 1

<h4>Background</h4>Conventional cardiac resynchronization therapy (CRT, Bi-V) is associated with no response in about 40% patients due to an insufficient resynchronization. Some studies showed triple-site ventricular (Tri-V) pacing had greater benefits compared with Bi-V pacing, but the results of these studies were conflicting. We hypothesized that Tri-V pacing had greater benefits on long-term outcomes compared with Bi-V pacing in patients with heart failure.<h4>Methods</h4>PubMed, EMBASE, and ...[more]

PMID: 29721114

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Project description:AimsThis registry was created to describe the experience of 76 Italian centres with a large cohort of recipients of multipoint pacing (MPP) capable cardiac resynchronization therapy (CRT) devices.Methods and resultsA total of 507 patients in whom these devices had been successfully implanted were enrolled between August 2013 and May 2015. We analysed: (i) current clinical practices for the management of such patients, and (ii) the impact of MPP on heart failure clinical composite response and on the absolute change in ejection fraction (EF) at 6 months. Multipoint pacing was programmed to 'ON' in 46% of patients before discharge. Methods of optimizing MPP programming were most commonly based on either the greatest narrowing of the QRS complex (38%) or the electrical delays between the electrodes (34%). Clinical and echocardiographic follow-up data were evaluated in 232 patients. These patients were divided into two groups according to whether MPP was programmed to 'ON' (n = 94) or 'OFF' (n = 138) at the time of discharge. At 6 months, EF was significantly higher in the MPP group than in the biventricular-pacing group (39.1 ± 9.6 vs. 34.7 ± 7.6%; P < 0.001). Even after adjustments, early MPP activation remained an independent predictor of absolute increase in LVEF of ≥5% (odds ratio 2.5; P = 0.001). At 6 months, an improvement in clinical composite score was recorded in a greater proportion of patients with MPP-ON than in controls (56 vs. 38%; P = 0.009). On comparing optimal MPP and conventional vectors, QRS was also seen to have decreased significantly (P < 0.001).ConclusionThis study provides information that is essential in order to deal with the expected increase in the number of patients receiving MPP devices in the coming years. The results revealed different practices among centres, and establishing the optimal programming that can maximize the benefit of MPP remains a challenging issue. Compared with conventional CRT, MPP improved clinical status and resulted in an additional increase in EF.Clinical trial registrationhttp://www.clinicaltrial.gov/. Unique identifier: NCT02606071.

Dataset Information

Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure: A meta-analysis of randomized and observational studies.

Publications

Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure: A meta-analysis of randomized and observational studies.

Similar Datasets

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