PMID- 27450156
OWN - NLM
STAT- MEDLINE
DCOM- 20180112
LR  - 20180120
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 13
IP  - 8
DP  - 2016 Aug
TI  - Optimization of left ventricular pacing site plus multipoint pacing improves 
      remodeling and clinical response to cardiac resynchronization therapy at 1 year.
PG  - 1644-51
LID - S1547-5271(16)30316-2 [pii]
LID - 10.1016/j.hrthm.2016.05.015 [doi]
AB  - BACKGROUND: Approximately one-third of the patients with heart failure (HF) 
      treated with cardiac resynchronization therapy (CRT) fail to respond. Positioning 
      the left ventricular (LV) pacing lead in the area of the latest electrical delay 
      may improve the response to CRT. Multipoint pacing (MPP) of the LV has been shown 
      to improve the acute hemodynamic response. OBJECTIVE: The purpose of this study 
      was to test the hypothesis that patients treated with MPP in whom LV pacing 
      location is optimized have better long-term clinical outcomes than do patients 
      treated with conventional CRT. METHODS: We evaluated the echocardiographic and 
      clinical response of 110 patients with HF treated for nearly 1 year with either 
      conventional CRT (standard [STD] group, n = 54, 49%), CRT with hemodynamic and 
      electrical optimization of the LV pacing site (optimized [OPT] group, n = 36, 
      33%), or OPT combined with MPP (OPT + MPP group, n = 20, 18%). Responders were 
      classified in terms of reduction in end-systolic volume index >/=15%, reduction in 
      New York Heart Association (NYHA) class >/=1, and Packer score variation (NYHA 
      response with no HF-related hospitalization events or death). RESULTS: In STD, 
      OPT, and OPT + MPP groups, 56%, 72%, and 90% of patients, respectively, were 
      end-systolic volume index responders (P = .004) and 67%, 78%, and 95% were NYHA 
      class responders (P = .012); 59%, 67%, and 90% of patients exhibited a 1-year 
      Packer score of 0 (P = .018). These trends remained significant after adjustment 
      for confounding factors by multivariate logistic analysis. CONCLUSION: Combining 
      MPP with optimal positioning of the LV lead on the basis of electrical delay and 
      hemodynamics enhances reverse remodeling and improves clinical outcomes beyond 
      the effect due to conventional CRT.
CI  - Copyright (c) 2016 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Zanon, Francesco
AU  - Zanon F
AD  - Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della 
      Misericordia Hospital, Rovigo, Italy. Electronic address: franc.zanon@iol.it.
FAU - Marcantoni, Lina
AU  - Marcantoni L
AD  - Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della 
      Misericordia Hospital, Rovigo, Italy.
FAU - Baracca, Enrico
AU  - Baracca E
AD  - Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della 
      Misericordia Hospital, Rovigo, Italy.
FAU - Pastore, Gianni
AU  - Pastore G
AD  - Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della 
      Misericordia Hospital, Rovigo, Italy.
FAU - Lanza, Daniela
AU  - Lanza D
AD  - Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
FAU - Fraccaro, Chiara
AU  - Fraccaro C
AD  - Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
FAU - Picariello, Claudio
AU  - Picariello C
AD  - Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
FAU - Conte, Luca
AU  - Conte L
AD  - Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
FAU - Aggio, Silvio
AU  - Aggio S
AD  - Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
FAU - Roncon, Loris
AU  - Roncon L
AD  - Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
FAU - Pacetta, Domenico
AU  - Pacetta D
AD  - St. Jude Medical, Agrate Brianza, Italy.
FAU - Badie, Nima
AU  - Badie N
AD  - St. Jude Medical, Sylmar, California.
FAU - Noventa, Franco
AU  - Noventa F
AD  - Department of Molecular Medicine, University of Padua, Padua, Italy.
FAU - Prinzen, Frits W
AU  - Prinzen FW
AD  - Cardiovascular Research Institute Maastricht, Maastricht University Medical 
      Center, Maastricht, The Netherlands.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Aged
MH  - Cardiac Resynchronization Therapy/*standards
MH  - Echocardiography
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/diagnosis/physiopathology/*therapy
MH  - Heart Ventricles/diagnostic imaging/*physiopathology
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Function, Left/*physiology
MH  - *Ventricular Remodeling
OTO - NOTNLM
OT  - Cardiac resynchronization therapy
OT  - Electrical delay
OT  - Heart failure
OT  - Hemodynamic response
OT  - Left ventricular pacing
OT  - Multipoint pacing
EDAT- 2016/07/28 06:00
MHDA- 2018/01/13 06:00
CRDT- 2016/07/25 06:00
PHST- 2015/12/23 00:00 [received]
PHST- 2016/07/25 06:00 [entrez]
PHST- 2016/07/28 06:00 [pubmed]
PHST- 2018/01/13 06:00 [medline]
AID - S1547-5271(16)30316-2 [pii]
AID - 10.1016/j.hrthm.2016.05.015 [doi]
PST - ppublish
SO  - Heart Rhythm. 2016 Aug;13(8):1644-51. doi: 10.1016/j.hrthm.2016.05.015.