PMID- 16360062
OWN - NLM
STAT- MEDLINE
DCOM- 20060302
LR  - 20071115
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 46
IP  - 12
DP  - 2005 Dec 20
TI  - Cardiac resynchronization with sequential biventricular pacing for the treatment 
      of moderate-to-severe heart failure.
PG  - 2298-304
AB  - OBJECTIVES: The InSync III study evaluated sequential cardiac resynchronization 
      therapy (CRT) in patients with moderate-to-severe heart failure and prolonged 
      QRS. BACKGROUND: Simultaneous CRT improves hemodynamic and clinical performance 
      in patients with moderate-to-severe heart failure (HF) and a wide QRS. Recent 
      evidence suggests that sequentially stimulating the ventricles might provide 
      additional benefit. METHODS: This multicenter, prospective, nonrandomized, 
      six-month trial enrolled a total of 422 patients to determine the effectiveness 
      of sequential CRT in patients with New York Heart Association (NYHA) functional 
      class III or IV HF and a prolonged QRS. The study evaluated: whether patients 
      receiving sequential CRT for six months experienced improvement in 6-min hall 
      walk (6MHW) distance, NYHA functional class, and quality of life (QoL) over 
      control group patients from the reported Multicenter InSync Randomized Clinical 
      Evaluation (MIRACLE) trial; whether sequential CRT increased stroke volume 
      compared to simultaneous CRT; and whether an increase in stroke volume translated 
      into greater clinical improvements compared to patients receiving simultaneous 
      CRT. RESULTS: InSync III patients experienced greater improvement in 6MHW, NYHA 
      functional class, and QoL at six months compared to control (all p < 0.0001). 
      Optimization of the sequential pacing increased (median 7.3%) stroke volume in 
      77% of patients. No additional improvement in NYHA functional class or QoL was 
      seen compared to the simultaneous CRT group; however, InSync III patients 
      demonstrated greater exercise capacity. CONCLUSIONS: Sequential CRT provided most 
      patients with a modest increase in stroke volume above that achieved during 
      simultaneous CRT. Patients receiving sequential CRT had improved exercise 
      capacity, but no change in functional status or QoL.
FAU - Leon, Angel R
AU  - Leon AR
AD  - Carlyle Fraser Heart Center/Division of Cardiology, Emory University, Atlanta, 
      Georgia, USA. angel_leon@emoryhealthcare.org
FAU - Abraham, William T
AU  - Abraham WT
FAU - Brozena, Susan
AU  - Brozena S
FAU - Daubert, James P
AU  - Daubert JP
FAU - Fisher, Westby G
AU  - Fisher WG
FAU - Gurley, John C
AU  - Gurley JC
FAU - Liang, Chang Seng
AU  - Liang CS
FAU - Wong, George
AU  - Wong G
CN  - InSync III Clinical Study Investigators
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Aged
MH  - Cardiac Output, Low/diagnosis/*physiopathology/*therapy
MH  - Cardiac Pacing, Artificial/*methods
MH  - Electrocardiography
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Quality of Life
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
MH  - Walking
EDAT- 2005/12/20 09:00
MHDA- 2006/03/03 09:00
CRDT- 2005/12/20 09:00
PHST- 2004/08/26 00:00 [received]
PHST- 2004/12/10 00:00 [revised]
PHST- 2004/12/14 00:00 [accepted]
PHST- 2005/12/20 09:00 [pubmed]
PHST- 2006/03/03 09:00 [medline]
PHST- 2005/12/20 09:00 [entrez]
AID - S0735-1097(05)02111-X [pii]
AID - 10.1016/j.jacc.2005.08.032 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2005 Dec 20;46(12):2298-304. doi: 10.1016/j.jacc.2005.08.032.