PMID- 23137504
OWN - NLM
STAT- MEDLINE
DCOM- 20130107
LR  - 20121109
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 164
IP  - 5
DP  - 2012 Nov
TI  - Randomized controlled trial comparing simultaneous versus optimized sequential 
      interventricular stimulation during cardiac resynchronization therapy.
PG  - 735-41
LID - S0002-8703(12)00526-1 [pii]
LID - 10.1016/j.ahj.2012.07.026 [doi]
AB  - BACKGROUND: Cardiac resynchronization therapy (CRT) reduces morbidity and 
      mortality and improves symptoms in patients with systolic heart failure (HF) and 
      ventricular dyssynchrony. This randomized, double-blind, controlled study 
      evaluated whether optimizing the interventricular stimulating interval (V-V) to 
      sequentially activate the ventricles is clinically better than simultaneous V-V 
      stimulation during CRT. METHODS: Patients with New York Heart Association (NYHA) 
      III or IV HF, meeting both CRT and implantable cardioverter-defibrillator 
      indications, randomly received either simultaneous CRT or CRT with optimized V-V 
      settings for 6 months. Patients also underwent echocardiography-guided 
      atrioventricular delay optimization to maximize left ventricular filling. The V-V 
      optimization involved minimizing the left ventricular septal to posterior wall 
      motion delay during CRT. The primary objective was to demonstrate noninferiority 
      using a clinical composite end point that included mortality, HF hospitalization, 
      NYHA functional class, and patient global assessment. Secondary end points 
      included changes in NYHA classification, 6-minute hall walk distance, quality of 
      life, peak VO(2), and event-free survival. RESULTS: The composite score improved 
      in 75 (64.7%) of 116 simultaneous patients and in 92 (75.4%) of 122 optimized 
      patients (P < .001, for noninferiority). A prespecified test of superiority 
      showed that more optimized patients improved (P = .03). New York Heart 
      Association functional class improved in 58.0% of simultaneous patients versus 
      75.0% of optimized patients (P = .01). No significant differences in exercise 
      capacity, quality of life, peak VO(2), or HF-related event rate between the 2 
      groups were observed. CONCLUSIONS: These findings demonstrate modest clinical 
      benefit with optimized sequential V-V stimulation during CRT in patients with 
      NYHA class III and IV HF. Optimizing V-V timing may provide an additional tool 
      for increasing the proportion of patients who respond to CRT.
CI  - Copyright (c) 2012 Mosby, Inc. All rights reserved.
FAU - Abraham, William T
AU  - Abraham WT
AD  - The Ohio State University Heart Center, Columbus, OH 43210-1252, USA. 
      william.abraham@osumc.edu
FAU - Leon, Angel R
AU  - Leon AR
FAU - St John Sutton, Martin G
AU  - St John Sutton MG
FAU - Keteyian, Steven J
AU  - Keteyian SJ
FAU - Fieberg, Ann M
AU  - Fieberg AM
FAU - Chinchoy, Ed
AU  - Chinchoy E
FAU - Haas, Garrie
AU  - Haas G
LA  - eng
SI  - ClinicalTrials.gov/NCT00271232
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20121002
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cardiac Pacing, Artificial/*methods
MH  - *Cardiac Resynchronization Therapy
MH  - Disease-Free Survival
MH  - Double-Blind Method
MH  - Echocardiography
MH  - Female
MH  - Heart Ventricles
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Quality of Life
MH  - Severity of Illness Index
MH  - Treatment Outcome
MH  - Walking
EDAT- 2012/11/10 06:00
MHDA- 2013/01/08 06:00
CRDT- 2012/11/10 06:00
PHST- 2008/04/13 00:00 [received]
PHST- 2012/07/10 00:00 [accepted]
PHST- 2012/11/10 06:00 [entrez]
PHST- 2012/11/10 06:00 [pubmed]
PHST- 2013/01/08 06:00 [medline]
AID - S0002-8703(12)00526-1 [pii]
AID - 10.1016/j.ahj.2012.07.026 [doi]
PST - ppublish
SO  - Am Heart J. 2012 Nov;164(5):735-41. doi: 10.1016/j.ahj.2012.07.026. Epub 2012 Oct 
      2.