Cardiac resynchronization therapy with left ventricular free wall stimulation yielded significantly larger increases in LV+dP/dt max compared with anterior wall stimulation (14% vs 6%, P<0.001).
RCT (n=30)
Does CRT with LV free wall stimulation improve systolic function compared to anterior wall stimulation in heart failure patients with ventricular conduction delay?
CRT with LV free wall stimulation produces significantly better acute LV systolic performance compared with anterior stimulation in heart failure patients.
Absolute Event Rate: 14% vs 6%
p-value: p=<0.001
Background — Cardiac resynchronization therapy (CRT) improves systolic function in heart failure patients with ventricular conduction delay by stimulating the left ventricle (LV) or both ventricles (biventricular, BV). Optimal LV site selection is of major clinical interest for CRT device implantation; however, the dependence of hemodynamics on LV stimulation site has not been established. Thus, the objective of this study was to compare the hemodynamic response to CRT for 2 LV coronary vein sites: the free wall and anterior wall. Methods and Results — A total of 30 patients (mean NYHA class, 2.7; mean QRS interval, 152 ms; mean PR interval, 194 ms) enrolled in the PATH-CHF-II trial were studied. CRT was administered with LV and BV stimulation in VDD mode at 4 AV delays. LV stimulation was at the lateral free wall or anterior wall, whereas right ventricular stimulation was fixed near the apex. LV+dP/dt max and aortic pulse pressure changes from baseline during CRT were compared for LV sites. Free wall sites with LV and BV stimulation yielded significantly larger LV+dP/dt max (14% versus 6%, P <0.001 for LV; 12% versus 5%, P <0.001 for BV) and pulse pressure (8% versus 4%, P <0.001 for LV; 9% versus 5%, P <0.001 for BV) compared with anterior sites. In one third of patients, CRT at free wall sites increased LV+dP/dt max , whereas it decreased at anterior sites over most AV delays. Conclusion — CRT with LV free wall stimulation produced significantly better LV systolic performance compared with anterior stimulation. Further studies are warranted to prove the clinical superiority of the LV free wall as a site for long-term CRT.
Butter et al. (2001) conducted an RCT in Heart failure with ventricular conduction delay (n=30). CRT with LV free wall stimulation vs. CRT with LV anterior wall stimulation was evaluated on LV+dP/dt max change from baseline during CRT (LV stimulation) (p=<0.001). Cardiac resynchronization therapy with left ventricular free wall stimulation yielded significantly larger increases in LV+dP/dt max compared with anterior wall stimulation (14% vs 6%, P<0.001).