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Long-Term Results of Triventricular Versus Biventricular Pacing in Heart Failure: A Propensity-Matched Comparison

Providencia, R; Rogers, D; Papageorgiou, N; Ioannou, A; James, A; Babu, G; Cobb, V; ... Chow, AWC; + view all (2016) Long-Term Results of Triventricular Versus Biventricular Pacing in Heart Failure: A Propensity-Matched Comparison. JACC: Clinical Electrophysiology , 2 (7) pp. 825-835. 10.1016/j.jacep.2016.05.015. Green open access

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Abstract

OBJECTIVES: The goal of this study was to assess the impact of triventricular pacing (Tri-V) on long-term survival. BACKGROUND: Biventricular pacing (Bi-V) is an important adjunctive treatment in advanced heart failure, but almost one-third of patients experience no improvement with this therapy and are labeled as nonresponders. Adding a third ventricular lead (Tri-V) has been shown to be feasible and provides favorable acute results when assessed by using echocardiographic, hemodynamic, and clinical endpoints. However, the long-term effects of Tri-V pacing and how it affects long-term survival remains unknown. METHODS: This single-center, propensity score-matched cohort study compared 34 patients with advanced heart failure who underwent implantation with Tri-V devices versus 34 control subjects treated with Bi-V pacing. Clinical outcomes during a median of 2,478 days (IQR: 1,183 to 3,214 days) were compared. RESULTS: Tri-V-treated patients compared with Bi-V-treated patients presented with a trend for shorter battery longevity (time to box change, 1,758 ± 360 days vs. 1,993 ± 408 days; p = 0.072). Incidence of lead dislodgement (Tri-V vs. Bi-V, 0.86 vs. 1.10 per 100 patient-years; p = 0.742), device-related infection (Tri-V vs. Bi-V, 1.83 vs. 1.76 per 100 patient-years; p = 0.996), and refractory phrenic nerve capture (Tri-V vs. Bi-V, 0.48 vs. 1.84 per 100 patient-years; p = 0.341) was comparable in the 2 groups. Episodes of ventricular arrhythmia requiring implantable cardioverter-defibrillator intervention occurred more frequently in the Bi-V group versus the Tri-V group (6.55 vs. 16.88 per 100 patient-years; adjusted hazard ratio: 0.31; 95% confidence interval: 0.14 to 0.66; p = 0.002). Lower all-cause mortality and heart transplant was observed in the Tri-V group compared with the Bi-V group (6.99 vs. 11.92 per 100 patient-years; adjusted hazard ratio: 0.44; 95% confidence interval: 0.23 to 0.85; p = 0.015). CONCLUSIONS: Tri-V displayed a similar safety profile compared with Bi-V and was associated with potential benefits regarding long-term survival and ventricular arrhythmia burden.

Type: Article
Title: Long-Term Results of Triventricular Versus Biventricular Pacing in Heart Failure: A Propensity-Matched Comparison
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jacep.2016.05.015
Publisher version: https://doi.org/10.1016/j.jacep.2016.05.015
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: arrhythmia, mortality, multisite pacing, nonresponders, refractory
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: https://discovery.ucl.ac.uk/id/eprint/10051975
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