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Paced or sensed conduction time to determine programming with cardiac resynchronization therapy: The PASED‐CRT Trial
Author(s) -
Corbisiero Raffaele,
Schmidt JoEllen,
Muller David,
Sookhu Sanjay,
Shah Meet,
Ochman Alexander,
Kazemain Pedram
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14212
Subject(s) - medicine , cardiac resynchronization therapy , heart failure , cardiology , randomized controlled trial , statistical significance , refractory (planetary science) , ejection fraction , physics , astrobiology
Background Cardiac resynchronization therapy (CRT) is a well‐established treatment for patients with drug refractory heart failure. Objectives This study sought to compare the longest RV sense to LV sense activation time (sLAT) versus the longest RV pace to LV sense activation time (pLAT) as the programmed site for left ventricular (LV) pacing in CRT patients with quadripolar LV leads at 3 months. Methods This single site, double‐blinded, prospective trial, randomized patients 1:1 into the sLAT or pLAT group to determine response. LV pacing was programmed at implant and maintained through 3 months of follow‐up. The 6‐minute hall walk (6MHW) test, NYHA, Minnesota living with heart failure, and clinical composite score (CCS) at the 3 months was compared. Results N = 92 patients (73M:19F age 66 ± 11.3 years) were randomized implanted and programmed per protocol. Baseline characteristics were comparable. N = 39 sLAT and N = 34 pLAT completed the 3‐month visit for final analysis. Significant improvement from baseline to 3 months was seen in the sLAT group from 253.9 (+/−11.5) to 323.1 (+/−11.9) P = .001. Similarly, the pLAT group improved from 274.9 (+/−16.15) to 343.9 (+/−15.9) P = .003. The difference between these groups, however, did not reach significance ( P = .86). The pLAT group demonstrated a higher responder rate of (71%) versus the sLAT group (64%) based on the CCS although not reaching significance ( P = .56). Conclusions Use of both the pLAT and sLAT method of programming demonstrated significant improvement in 6MHW distance at 3 months with pLAT demonstrating a slightly higher responder rate based on CCS ( P = .56). pLAT should be considered at minimum as equivalent in patients with no intrinsic conduction.