Abstract
Purpose Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVAD) independently improve outcomes in heart failure patients, but the effects of combining these therapies remain unknown. We present the full study cohort of the first prospective study evaluating outcomes with right ventricular (RV) vs biventricular (BiV) pacing in LVAD patients. Methods We performed a prospective, randomized, crossover study. LVAD patients with previously implanted CRT devices were randomized to RV or BiV pacing for 7 days. After data collection, the pacing mode was switched for an additional 7 days. Ambulatory step count (by Fitbit Zip device), 6 minute walk test (6MWT) distance, Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores, arrhythmia burden, ICD lead function, and echocardiographic data were collected with each pacing mode. Results 30 patients were enrolled, with a mean age of 61 years, 67% male, and median duration of LVAD support of 343 days. During RV pacing, mean daily step count was 21% higher compared to BiV pacing (2177 vs. 1798 steps, p = 0.001). With RV pacing, there was a 9% higher 6MWT distance (313 vs. 288 m, p = 0.003). KCCQ-12 score was significantly higher with RV pacing (45.8 vs 43.7, p = 0.02). There were significantly fewer patients with ventricular tachyarrhythmia episodes with RV pacing (8% vs 19%, p=0.04); one patient had 4 episodes of sustained ventricular tachycardia requiring anti-tachycardia pacing during BiV pacing. No significant difference was observed in lead impedance between RV and BiV pacing with the right atrial, right ventricular, and left ventricular leads. Conclusion In the first prospective randomized study comparing variable pacing in LVAD patients, RV pacing was associated with significantly improved functional status, quality of life, and ventricular tachyarrhythmia burden compared to BiV pacing. We recommend turning off LV lead pacing in patients on LVAD support with CRT devices.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
