Key result
Active epicardial CRT during CABG improves NYHA class, 6MWD, quality of life, and LVEF.
Why the study?
Does active totally epicardial CRT implanted during CABG improve clinical and echocardiographic parameters in patients with heart failure and dyssynchrony compared to inactive CRT?
RCT (n=23)
single-blind
randomised cross-over
Does active totally epicardial CRT implanted during CABG improve clinical and echocardiographic parameters in patients with heart failure and dyssynchrony compared to inactive CRT?
p-value: p=0.028
Totally epicardial CRT implanted during CABG provides significant clinical and echocardiographic benefits in patients with heart failure and systolic dyssynchrony.
Supports epicardial CRT at CABG in HF with dyssynchrony; extends randomized evidence for perioperative resynchronization.
BACKGROUND: Systolic dyssynchrony is present in a considerable number of patients with heart failure (HF) undergoing coronary artery bypass grafting (CABG). Surgical revascularization offers an optimal setting for totally epicardial cardiac resynchronization therapy (CRT) system implantation. AIM: To assess the efficacy of totally epicardial CRT implantation during CABG, in patients with HF. METHODS: Twenty three patients with HF and dyssynchrony underwent totally epicardial CRT system implantation during CABG. This randomised, single-blind, cross-over study compared clinical and echocardiographic parameters during two periods: 3 months of active CRT (CRT+) and 3 months of inactive CRT (CRT-) pacing. RESULTS: Twenty two patients underwent randomisation and completed both study periods. In the CRT+ group more patients improved by two NYHA classes (p=0.028), had a longer 6-minute walk test distance (p=0.047) and better quality of life (p=0.003) compared with the CRT- group. Echocardiography revealed an improved LV ejection fraction (p<0.001), smaller LV end-systolic volume (p=0.04), reduced mitral regurgitation (p=0.026) and improved LV synchrony in the CRT+ group compared with the CRT- group. CONCLUSION: CRT delivered by a totally epicardial system implanted during CABG is associated with additional improvement of clinical and echocardiographic parameters in patients with HF and systolic dyssynchrony.
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Gościńska-Bis et al. (2008) conducted an RCT in Heart failure and systolic dyssynchrony (n=23). Active totally epicardial cardiac resynchronization therapy (CRT+) vs. Inactive CRT (CRT-) pacing was evaluated on Clinical and echocardiographic parameters (including improvement by two NYHA classes) (p=0.028). Active epicardial CRT pacing during CABG improved NYHA class (p=0.028), 6-minute walk distance (p=0.047), quality of life (p=0.003), and LV ejection fraction (p<0.001) compared to inactive pacing.
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