Author + information
- Received April 4, 2016
- Accepted May 12, 2016
- Published online December 1, 2016.
- Rui Providencia, MD, PhD,
- Dominic Rogers, MD,
- Nikolaos Papageorgiou, MD, PhD,
- Adam Ioannou, MBBS, BSc,
- Anthony James, MBBS, BSc,
- Girish Babu, MD,
- Vanessa Cobb, MD,
- Syed Ahsan, MD,
- Oliver R. Segal, MD,
- Edward Rowland, MD,
- Martin Lowe, PhD,
- Pier D. Lambiase, PhD and
- Anthony W.C. Chow, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Anthony Chow, Barts Heart Centre, Barts Health NHS Trust, Electrophysiology Department, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
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.
Dr. Providencia has received a training grant from Boston Scientific and Sorin Group; and a research grant from Medtronic. Dr. Lambiase has received research grants and speakers fees from Boston Scientific and St. Jude; and research grants from Medtronic and Biotronik. Dr. Rogers has served as a member of the advisory board of St. Jude Medical. Dr. Segal has received speakers fees from Bayer Ltd., Bayliss Ltd., Medtronic Ltd., and Biosense-Webster Ltd. Dr. Chow has received speaker honoraria from Bayer; and consultant honoraria from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 4, 2016.
- Accepted May 12, 2016.
- American College of Cardiology Foundation