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Benefits of left ventricular endocardial pacing comparing failed implants and prior non-responders to conventional cardiac resynchronization therapy: A subanalysis from the ALSYNC study.
- Source :
-
International journal of cardiology [Int J Cardiol] 2018 May 15; Vol. 259, pp. 88-93. - Publication Year :
- 2018
-
Abstract
- Objective: Cardiac resynchronisation therapy (CRT) is limited by a substantial proportion of non-responders. Left ventricular endocardial pacing (LVEP) may offer enhanced possibility to deliver CRT in patients with a failed attempt at implantation and to improve clinical status of CRT non-responders.<br />Methods: The ALternate Site Cardiac ResYNChronisation (ALSYNC) study was a prospective, multi-centre cohort study that included 118 CRT patients with a successfully implanted endocardial left ventricular (LV) lead, including 90 failed coronary sinus (CS) implants and 28 prior non-responders who had worsened or unchanged heart failure status after at least 6 months of optimal conventional CRT therapy.<br />Results: Patients were followed for 19 ± 9 months. At baseline, prior non-responders were sicker as evidenced by a larger LV end-diastolic diameter (70 ± 12 vs 65 ± 9 mm, p = .03) and a trend towards larger LV end-systolic volume index (LVESVi, 95 ± 51 vs 74 ± 39 ml/m <superscript>2</superscript> , p = .07), and were more frequently anti-coagulated (96% vs 72%, p = .008) despite similar history of atrial fibrillation (54% vs 51%, p = .83). At 6 months, LVEP significantly improved LV ejection fraction (2.3 ± 7.5 and 8.6 ± 10.0%), New York Heart Association Class (0.4 ± 0.9 and 0.7 ± 0.8), LVESVi (9 ± 16 and 18 ± 43 ml/m <superscript>2</superscript> ), and six-minute walk test (56 ± 73 and 54 ± 92 m) in prior non-responders and failed CS implants, relative to baseline (all p < .05), respectively. LVESVi reduction ≥15% was seen in 47% of the prior non-responder patients and 57% of failed CS patients.<br />Conclusion: These data suggest that a sizable proportion of CRT non-responders can improve by LVEP, though to a lesser extent than failed CS implants. Clinical trial registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01277783.<br /> (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Cardiac Resynchronization Therapy standards
Cardiac Resynchronization Therapy Devices standards
Cohort Studies
Female
Follow-Up Studies
Heart Failure diagnostic imaging
Heart Failure physiopathology
Humans
Male
Middle Aged
Prospective Studies
Treatment Outcome
Ventricular Dysfunction, Left diagnostic imaging
Ventricular Dysfunction, Left physiopathology
Cardiac Resynchronization Therapy trends
Cardiac Resynchronization Therapy Devices trends
Equipment Failure
Heart Failure therapy
Stroke Volume physiology
Ventricular Dysfunction, Left therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 259
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 29579617
- Full Text :
- https://doi.org/10.1016/j.ijcard.2018.01.030