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- Title
Multisite cardiac resynchronization therapy for traditional and non-traditional indications.
- Authors
Laish-Farkash, Avishag; Bruoha, Sharon; Khalameizer, Vladimir; Yosefy, Chaim; Michowitz, Yoav; Suleiman, Mahmoud; Katz, Amos
- Abstract
<bold>Purpose: </bold>Multisite cardiac resynchronization therapy (MSCRT) with dual-vein left ventricular (LV) pacing has theoretical advantages over conventional CRT in faster and more physiological LV activation. We aimed to define indications, feasibility, safety, acute, and long-term results of MSCRT.<bold>Methods: </bold>All patients implanted with MSCRT during 2008-2014 in a single center were reviewed and analyzed.<bold>Results: </bold>Thirty-nine patients (90% CRT-defibrillators, 64 ± 9 years, 85% male, 74% ischemic etiology) were included. Four groups of indications were recognized: (1) significant tricuspid regurgitation (TR) in patients planned for device implantation without right ventricular lead (n = 3). Follow-up (f/u) of 4 ± 3 years showed major symptomatic improvement in all, with stable LV size and function and deferral of valve surgery; (2) severe heart failure with reduced ejection fraction (HFrEF) and refractory ventricular tachycardia (VT) (n = 4). Except for 1 early death for acute renal failure, all others showed no VT episodes and HF improvement (f/u 4.5 ± 0.5 years); (3) severe HFrEF and wide QRS (≥ 150 ms) or failure of biventricular pacing to narrow QRS during implantation (n = 5). One patient had periprocedural mortality. The others had major clinical improvement; (4) severe HF and narrow QRS/RBBB (n = 27). 23/24 patients with available f/u of 3 ± 1.7 years improved clinically and 57% had EF improvement. In 3 patients, LV1 was disabled and one had LV2 dislodgement.<bold>Conclusions: </bold>MSCRT is feasible, safe, and valuable in selected patients with a need to avoid RV lead during device implantation, refractory VT with no other solution, severe HFrEF with wide QRS or CRT non-responsiveness, and severe HF without LBBB. Randomized controlled studies are required.
- Subjects
CARDIAC pacing; LEFT heart ventricle; TRICUSPID valve; MORTALITY; RANDOMIZED controlled trials
- Publication
Journal of Interventional Cardiac Electrophysiology, 2018, Vol 51, Issue 2, p143
- ISSN
1383-875X
- Publication type
journal article
- DOI
10.1007/s10840-018-0316-4