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Eur Heart J. 2016 Feb 1;37(5):473-83. doi: 10.1093/eurheartj/ehv422. Epub 2015 Sep 15.

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

Collaborators (159)

Dupuis JM, Rouleau F, Tassin A, Bordachar P, Clémenty J, Lafitte S, Ploux S, Reant P, Ritter P, Defaye P, Jacon P, Mondesert B, Saunier C, Vautrin E, Kacet S, Guedon-Moreau L, Klug D, Kouakam C, Marechaux S, Marquie C, Polge AS, Richardson M, Chevallier P, De Breyne B, Lotek MM, Nonin E, Pineau J, Deharo JC, Bastard E, Franceschi F, Habib G, Jego C, Peyrouse E, Prevot S, Saint-Joseph H, Bremondy M, Faure J, Ferracci A, Lefevre J, Pisapia A, Davy JM, Cransac F, Cung TT, Georger F, Pasquie JL, Raczka F, Sportouch-Dukhan C, Sadoul N, Blangy H, Bruntz JF, Freysz L, Groben L, Huttin O, Bammert A, Burban M, Cebron JP, Gras D, Frank R, Duthoit G, Hidden-Lucet F, Himbert C, Isnard R, Lacotte J, Pousset F, Zerah T, Leclercq C, Bellouin A, Crocq C, Deplace C, Donal E, Hamon C, Mabo P, Romain O, Solnon A, Frederic A, Bauer F, Bernard M, Godin B, Kurtz B, Savoure A, Copie X, Lascault G, Paziaud O, Piot O, Touche T, Delay TM, Chilon T, Detis N, Duparc A, Hebrard A, Massabuau P, Maury P, Mondoly P, Rumeau P, Pasteur C, Boveda S, Adrover L, Combes N, Deplagne A, Marco-Baertich I, Fondard O, Martínez JG, Ibañez Criado JL, Ortuño D, Mont L, Berruezo A, Eduard B, Martín A, Merschon FM, Sitges M, Tolosana JM, Vidal B, Hebron HV, I Mitjans AM, Rodriguez OA, Rodriguez Palomares JF, Rivas N, Teixidó G, de Hierro HP, Lozano IF, Ruiz Bautista ML, Castro V, Cavero MA, Gutierrez C, Ros N, de la Victoria HV, Alzueta Rodriguez FJ, Cabrera F, Cordero AB, Peña JL, de Valme Sevilla H, Gonzáles JL, Garcia Medina MD, Jiménez RP, Villagomez D, de la Salud Toledo HV, Castellanos Martinez E, Alcalá J, Maicas C, Arias Palomares MA, Puchol A, Valencia HL, OscaAsensi J, Carmona AQ, De Carranza MJ, De Ros JO, Pareja EC, Pérez OC, Saez AO, Hortega HR, Guilarte BH, Muñoz San Jose JF, Pérez Sanz TM, Logeart D, Gil ML, Leclercq C, Lozano IF, de Hierro HP, Derumeaux G.

Author information

1
Centre Hospitalier Universitaire, Rennes, France Université Rennes 1, Rennes, France Université Inserm U642, Rennes, France christophe.leclercq@chu-rennes.fr.
2
Centre Hospitalier Universitaire, Nancy, France.
3
Hospital Clinic Universitat de Barcelona, Catalonia, Spain.
4
Centre Hospitalier Universitaire, Grenoble, France.
5
Hospital La Fé, Valencia, Spain.
6
Boston Scientific SAS, Voisins le Bretonneux, France.
7
Centre Hospitalier Universitaire la Pitié-Salpêtrière, Paris, France.
8
Centre Hospitalier Universitaire La Timone, Marseille, France.
9
University Hospital Ramón y Cajal, Madrid, Spain.
10
DHU A-TVB, Hôpital Henri Mondor, Créteil, France.
11
Hospital Puerta de Hierro, Madrid, Spain.

Abstract

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.

KEYWORDS:

Cardiac resynchronization therapy; Left ventricular end-systolic volume; Right ventricular defibrillation lead; Right ventricular lead position

PMID:
26374852
PMCID:
PMC5841219
DOI:
10.1093/eurheartj/ehv422
[Indexed for MEDLINE]
Free PMC Article

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