Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study

AIMS: Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was n...

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Detalles Bibliográficos
Autores principales: Leclercq, Christophe, Sadoul, Nicolas, Mont, Lluis, Defaye, Pascal, Osca, Joaquim, Mouton, Elisabeth, Isnard, Richard, Habib, Gilbert, Zamorano, Jose, Derumeaux, Genevieve, Fernandez-Lozano, Ignacio, Dupuis, Jean-Marc, Rouleau, Frédéric, Tassin, Aude, Bordachar, Pierre, Clémenty, Jacques, Lafitte, Stephane, Ploux, Sylvan, Reant, Patricia, Ritter, Philippe, Jacon, Peggy, Mondesert, Blandine, Saunier, Carole, Vautrin, Estelle, Kacet, Salem, Guedon-Moreau, Laurence, Klug, Didier, Kouakam, Claude, Marechaux, Sylvestre, Marquie, Christelle, Polge, Anne Sophie, Richardson, Marjorie, Chevallier, Philippe, De Breyne, Brigitte, Lotek, Marcin M., Nonin, Emilie, Pineau, Julien, Deharo, Jean-Claude, Bastard, Emilie, Franceschi, Frédéric, Jego, Christophe, Peyrouse, Eric, Prevot, Sebastien, Saint-Joseph, Hôpital, Bremondy, Michel, Faure, Jacques, Ferracci, Ange, Lefevre, Jean, Pisapia, Andre, Davy, Jean-Marc, Cransac, Frederic, Cung, Tien Tri, Georger, Frederic, Pasquie, Jean-Luc, Raczka, Franck, Sportouch-Dukhan, Catherine, Blangy, Hugues, Bruntz, Jean-François, Freysz, Luc, Groben, Laurent, Huttin, Olivier, Bammert, Antoine, Burban, Marc, Cebron, Jean-Pierre, Gras, Daniel, Frank, Robert, Duthoit, Guillaume, Hidden-Lucet, Françoise, Himbert, Caroline, Lacotte, Jérôme, Pousset, Françoise, Zerah, Thierry, Bellouin, Annaïk, Crocq, Christophe, Deplace, Christian, Donal, Erwan, Hamon, Cécile, Mabo, Philippe, Romain, Olivier, Solnon, Aude, Frederic, Anselme, Bauer, Fabrice, Bernard, Mathieu, Godin, Benedicte, Kurtz, Baptiste, Savoure, Arnaud, Copie, Xavier, Lascault, Gilles, Paziaud, Olivier, Piot, Olivier, Touche, Thierry, Delay, Toulouse Marc, Chilon, Talia, Detis, Nicolas, Duparc, Alexandre, Hebrard, Aurélien, Massabuau, Pierre, Maury, Philippe, Mondoly, Pierre, Rumeau, Philippe, Pasteur, Clinique, Boveda, Serge, Adrover, Laurence, Combes, Nicolas, Deplagne, Antoine, Marco-Baertich, Isabelle, Fondard, Olivier, Martínez, Juan Gabriel, Ibañez Criado, José Luis, Ortuño, Diego, Berruezo, Antonio, Eduard, Belu, Martín, Ana, Merschon, Franco M., Sitges, Marta, Tolosana, José María, Vidal, Bárbara, Hebron, H. Valle, i Mitjans, Angel Moya, Rodriguez, Oscar Alcalde, Rodriguez Palomares, José Fernando, Rivas, Nuria, Teixidó, Gisela, de Hierro, H. Puerta, Lozano, Ignacio Fernández, Ruiz Bautista, Maria Lorena, Castro, Victor, Cavero, Miguel Angel, Gutierrez, Carlos, Ros, Natalia, de la Victoria, H. Virgen, Alzueta Rodriguez, Francisco Javier, Cabrera, Fernando, Cordero, Alberto Barrera, Peña, José Luis, de Valme Sevilla, H., Gonzáles, Juan Lealdel Ojo, Garcia Medina, Mª Dolores, Jiménez, Ricardo Pavón, Villagomez, David, de la Salud Toledo, H. Virgen, Castellanos Martinez, Eduardo, Alcalá, Juan, Maicas, Carolina, Arias Palomares, Miguel Angel, Puchol, Alberto, Valencia, H. La Fé, OscaAsensi, Joaquim, Carmona, Anastasio Quesada, De Carranza, Mª José Sancho-Tello, De Ros, José Olagüe, Pareja, Enrique Castro, Pérez, Oscar Cano, Saez, Ana Osa, Hortega, H. Rio, Guilarte, Benito Herreros, Muñoz San Jose, Juan Francisco, Pérez Sanz, Teresa Myriam, Logeart, Damien, Gil, Maria Lopez, Lozano, Ignacio Fernandez
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Clinical Research
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841219/
https://www.ncbi.nlm.nih.gov/pubmed/26374852
http://dx.doi.org/10.1093/eurheartj/ehv422
Descripción
Sumario:AIMS: Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator. METHODS AND RESULTS: Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (−25.3 ± 39.4 mL in RVS group vs. −29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = −4.06 mL; P = 0.006 with a −20 mL non-inferiority margin). The percentage of ‘echo-responders’ defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401). CONCLUSION: This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. CLINICALTRIALS. GOV NUMBER: NCT 00833352.

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