Background: We compared clinical and technical outcome of CRT recipients treated either with a conventional 3-leads (3L) CRTD or with the new 2-leads (DX) CRTD that enables atrial signal detection by a floating dipole built on a pentafilar RV lead. Methods: Echocardiography and cardiopulmonary exercise tests were repeated either before CRTD implantation and between 6 and 12 months follow up in consecutively implanted patients who had a resting heart rate. >. 40. bpm at maximum tolerated beta-blocker dosage. HF status, reverse LV remodeling, exercise tolerance and chronotropic incompetence were assessed at 12 months FU. Device diagnostics were obtained twice yearly until December 2016. Results: 37 patients aged 66 (58-73) years were consecutively implanted in 2013-2014 according to current guidelines, 25 with a 3L CRTD and 12 with a DX CRTD. Beta-blocker dosage was similar, and no difference between the 2 groups was observed in terms of NYHA class improvement, LV reverse remodeling, peak cardiopulmonary performance and presence of chronotropic incompetence at 12 months follow up. There was no difference in: amount delivered CRT; occurrence of VT/VF; occurrence of AT/AF. No patients developed need of atrial stimulation at 3-years FU. Atrial undersensing never occurred in any patient, whereas Far-field R-wave oversensing was more common in 3L patient than in DX patients (8/25 vs none, P <. 0.05). P wave amplitude was greater in DX vs 3L patients [5.1(3.7-9.2) vs 2.9(2-3.9) mV, P <. 0.01]. Conclusion: CRT can be achieved with two-leads-only in the majority of patients, provided that indication to atrial stimulation is ruled out.

Less is more: Can we achieve cardiac resynchronization with 2 leads only?

Biffi, Mauro;Massaro, Giulia;Angeletti, Andrea;Diemberger, Igor
;
Ziacchi, Matteo
2017

Abstract

Background: We compared clinical and technical outcome of CRT recipients treated either with a conventional 3-leads (3L) CRTD or with the new 2-leads (DX) CRTD that enables atrial signal detection by a floating dipole built on a pentafilar RV lead. Methods: Echocardiography and cardiopulmonary exercise tests were repeated either before CRTD implantation and between 6 and 12 months follow up in consecutively implanted patients who had a resting heart rate. >. 40. bpm at maximum tolerated beta-blocker dosage. HF status, reverse LV remodeling, exercise tolerance and chronotropic incompetence were assessed at 12 months FU. Device diagnostics were obtained twice yearly until December 2016. Results: 37 patients aged 66 (58-73) years were consecutively implanted in 2013-2014 according to current guidelines, 25 with a 3L CRTD and 12 with a DX CRTD. Beta-blocker dosage was similar, and no difference between the 2 groups was observed in terms of NYHA class improvement, LV reverse remodeling, peak cardiopulmonary performance and presence of chronotropic incompetence at 12 months follow up. There was no difference in: amount delivered CRT; occurrence of VT/VF; occurrence of AT/AF. No patients developed need of atrial stimulation at 3-years FU. Atrial undersensing never occurred in any patient, whereas Far-field R-wave oversensing was more common in 3L patient than in DX patients (8/25 vs none, P <. 0.05). P wave amplitude was greater in DX vs 3L patients [5.1(3.7-9.2) vs 2.9(2-3.9) mV, P <. 0.01]. Conclusion: CRT can be achieved with two-leads-only in the majority of patients, provided that indication to atrial stimulation is ruled out.
Biffi, Mauro; Massaro, Giulia; Candelora, Andrea; Angeletti, Andrea; Valzania, Cinzia; Martignani, Cristian; Grassini, Diego; Diemberger, Igor; Ziacchi, Matteo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/618850
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