Abstract
BackgroundType 2 diabetes mellitus (T2DM) is a multi factorial disease, affecting clinical outcomes in failing heart patients treated by cardiac resynchronization therapy with a defibrillator (CRT-d).MethodsOne hundred and ninety-five T2DM patients received a CRT-d treatment. Randomly the study population received a CRT-d via multipolar left ventricle (LV) lead pacing (n 99, multipolar group), vs a CRT-d via bipolar LV pacing (n 96, bipolar group). These patients were followed by clinical, and instrumental assessment, and telemetric device control at follow up. In this study we evaluated, in a population of failing heart T2DM patients, cardiac deaths, all cause deaths, arrhythmic events, CRT-d responders rate, hospitalizations for HF worsening, phrenic nerve stimulation (PNS), and LV catheter dislodgment events (and re-intervention for LV catheter re-positioning), comparing multipolar CRT-d vs bipolar CRT-d group of patients at follow up.ResultsAt follow up there was a statistical significant difference about atrial arrhythmic events [7 (7%) vs 16 (16.7%), p value 0.019], hospitalizations for HF worsening [15 (15.2% vs 24 (25%), p value 0.046], LV catheter dislodgments [1 (1%) vs 9 (9.4%), p value 0018], PNS [5 (5%) vs 18 (18.7%), p value 0.007], and LV re-positioning [1 (1%) vs 9 (9.4%), p value 0.018], comparing multipolar CRT-d vs bipolar CRT-d group of patients. Multipolar pacing was an independent predictor of all these events.ConclusionsCRT-d pacing via multipolar LV lead vs bipolar LV lead may reduce arrhythmic burden, hospitalization rate, PNS, LV catheters dislodgments, and re-interventions in T2DM failing heart patients.Clinical trial number NCT03095196
Highlights
Type 2 diabetes mellitus (T2DM) is a multi factorial disease, affecting clinical outcomes in failing heart patients treated by cardiac resynchronization therapy with a defibrillator (CRT-d)
Our study hypothesis was that, in T2DM failing heart patients multipolar left ventricle (LV) pacing may lead to a reduction of phrenic nerve stimulation (PNS) episodes, LV leads dislodgments, and interventions to re-positioning LV leads as compared to bipolar LV pacing
One hundred and ninety-five T2DM failing heart patients treated by a CRT-d completed the study follow up, 99 multipolar vs 95 bipolar CRT-d patients (Fig. 1)
Summary
Type 2 diabetes mellitus (T2DM) is a multi factorial disease, affecting clinical outcomes in failing heart patients treated by cardiac resynchronization therapy with a defibrillator (CRT-d). The advancement of CRT-d technology worked to reduce implant complications, as phrenic nerve stimulation (PNS), and left ventricle (LV) leads dislodgments [13], and to improve clinical outcomes in CRT-d patients [14]. In this setting, CRT-d pacing via a multipolar LV lead may represent one of these technological advancements. Our study hypothesis was that, in T2DM failing heart patients multipolar LV pacing may lead to a reduction of PNS episodes, LV leads dislodgments, and interventions to re-positioning LV leads as compared to bipolar LV pacing. In T2DM failing heart patients, CRT-d via multipolar LV lead vs bipolar LV lead may induce an amelioration of the HF clinical status, and of the CRT-d responders rate
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