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Europace Advance Access published online on July 13, 2007
Europace, doi:10.1093/europace/eum140
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Triple-site biventricular pacing in patients undergoing cardiac resynchronization therapy: a feasibility study

Radoslaw Lenarczyk*, Oskar Kowalski, Tomasz Kukulski, Mariola Szulik, Patrycja Pruszkowska-Skrzep, Teresa Zielinska, Jacek Kowalczyk, Slawomir Pluta, Agata Duszanska, Beata Sredniawa, Agata Musialik-Lydka and Zbigniew Kalarus

First Department of Cardiology, Silesian Center for Heart Disease, Silesian Medical School, ul. Szpitalna 2, 41-800 Zabrze, Poland

Aims To evaluate implantation safety and efficiency of triple-site (double left–single right) cardiac resynchronization therapy (CRT) and to assess the outcome of this procedure.

Methods and results Twenty-six patients with New York Heart Association (NYHA) class III–IV, left ventricular ejection fraction (EF) ≤ 35%, and QRS ≥ 120 ms underwent triple-site CRT. Procedural course and complications were analysed. NYHA class, QRS duration, echocardiographic parameters, peak oxygen consumption (VO2max), and 6 min walking distance (6MWD) were assessed at baseline and after 3 months. Responders were defined by survival, by no re-hospitalization for heart failure, and by >10% EF, VO2max, and 6MWD increase. Implantation was successful in 22 patients (84.6%). Procedure duration (199.1 min) and fluoroscopy time (38.7 min) were higher than in standard procedures. Two clinically silent coronary sinus dissections occurred intra-operatively; one phrenic nerve stimulation and one pocket infection were observed during follow-up. After 3 months of CRT, a significant reduction (P < 0.05) of NYHA class, increment of VO2max, 6MWD, EF, and improvement of indices of dyssynchrony were observed. Response rate in the studied group was 95.4%.

Conclusion Triple-site resynchronization appears to be a safe and efficient treatment method, with high response rate. Further studies are needed to evaluate the role of this pacing mode in CRT.

Key Words: Heart failure, Multisite pacing, Resynchronization therapy, Non-invasive assessment, Echocardiography

* Corresponding author. Tel: +48 32 271 34 14; fax: +48 32 271 76 92. E-mail address: elfizab{at}poczta.onet.pl

Manuscript submitted 21 March 2007. Accepted after revision 20 June 2007.


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