Longest Paced versus Sensed Electrical Delay Programming in Cardiac Resynchronization Therapy Defibrillator Patients with Quadripolar LV Leads: Results from the PASED-CRT Randomized Trial

Abstract

Introduction Cardiac resynchronization therapy (CRT) is a well-established treatment for patients with drug refractory heart failure. The PASED-CRT trial (NCT-02803775) compared the efficacy of the longest RVsense to LVsense activation time (sLAT) versus the longest RVpace to LVsense activation time (pLAT) as the site of the LV pacing cathode on quadripolar LV leads. Methods The PASED-CRT trial is a single site, double blind, randomized, prospective trial. Patients were randomized to sLAT or pLAT in a 1:1 ratio. The site of Left ventricular pacing was programmed bases on the longest electrical delay measured and maintained thru 3 months. Blinded physicians and assessors compared the 6-minute hall walk test (6MWT), NYHA, MLWHF, and Clinical Composite Score (CCS) at 3 months. Results N=92 patients (20%F) 66 (±11.3 years) were randomized and programmed per protocol. Patients and physicians were blinded to programming assignment. Baseline patient characteristics were comparable between groups. N=38 sLAT and N=34 pLAT completed the 3 month visit for the final analysis. The pLAT group had a greater CCS compared 82.4% vs. the sLAT 55.3% (P=0.016) and had a mean 20.63m increase over the sLAT in 6MWT distance at 3 months. (P=N/S) Conclusions Utilizing the pLAT demonstrated improved 6MWT distance and a significant difference in CCS over the programming to the sLAT. These results should be considered in patients with intrinsic conduction and those without as no measurement is currently available. Future studies with longer follow-ups are warranted to confirm these findings.