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Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure.

Publication ,  Journal Article
León, AR; Abraham, WT; Brozena, S; Daubert, JP; Fisher, WG; Gurley, JC; Liang, CS; Wong, G; InSync III Clinical Study Investigators,
Published in: J Am Coll Cardiol
December 20, 2005

OBJECTIVES: The InSync III study evaluated sequential cardiac resynchronization therapy (CRT) in patients with moderate-to-severe heart failure and prolonged QRS. BACKGROUND: Simultaneous CRT improves hemodynamic and clinical performance in patients with moderate-to-severe heart failure (HF) and a wide QRS. Recent evidence suggests that sequentially stimulating the ventricles might provide additional benefit. METHODS: This multicenter, prospective, nonrandomized, six-month trial enrolled a total of 422 patients to determine the effectiveness of sequential CRT in patients with New York Heart Association (NYHA) functional class III or IV HF and a prolonged QRS. The study evaluated: whether patients receiving sequential CRT for six months experienced improvement in 6-min hall walk (6MHW) distance, NYHA functional class, and quality of life (QoL) over control group patients from the reported Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial; whether sequential CRT increased stroke volume compared to simultaneous CRT; and whether an increase in stroke volume translated into greater clinical improvements compared to patients receiving simultaneous CRT. RESULTS: InSync III patients experienced greater improvement in 6MHW, NYHA functional class, and QoL at six months compared to control (all p < 0.0001). Optimization of the sequential pacing increased (median 7.3%) stroke volume in 77% of patients. No additional improvement in NYHA functional class or QoL was seen compared to the simultaneous CRT group; however, InSync III patients demonstrated greater exercise capacity. CONCLUSIONS: Sequential CRT provided most patients with a modest increase in stroke volume above that achieved during simultaneous CRT. Patients receiving sequential CRT had improved exercise capacity, but no change in functional status or QoL.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 20, 2005

Volume

46

Issue

12

Start / End Page

2298 / 2304

Location

United States

Related Subject Headings

  • Walking
  • Treatment Outcome
  • Time Factors
  • Severity of Illness Index
  • Quality of Life
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • Female
 

Citation

APA
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ICMJE
MLA
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León, A. R., Abraham, W. T., Brozena, S., Daubert, J. P., Fisher, W. G., Gurley, J. C., … InSync III Clinical Study Investigators, . (2005). Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure. J Am Coll Cardiol, 46(12), 2298–2304. https://doi.org/10.1016/j.jacc.2005.08.032
León, Angel R., William T. Abraham, Susan Brozena, James P. Daubert, Westby G. Fisher, John C. Gurley, Chang Seng Liang, George Wong, and George InSync III Clinical Study Investigators. “Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure.J Am Coll Cardiol 46, no. 12 (December 20, 2005): 2298–2304. https://doi.org/10.1016/j.jacc.2005.08.032.
León AR, Abraham WT, Brozena S, Daubert JP, Fisher WG, Gurley JC, et al. Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure. J Am Coll Cardiol. 2005 Dec 20;46(12):2298–304.
León, Angel R., et al. “Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure.J Am Coll Cardiol, vol. 46, no. 12, Dec. 2005, pp. 2298–304. Pubmed, doi:10.1016/j.jacc.2005.08.032.
León AR, Abraham WT, Brozena S, Daubert JP, Fisher WG, Gurley JC, Liang CS, Wong G, InSync III Clinical Study Investigators. Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure. J Am Coll Cardiol. 2005 Dec 20;46(12):2298–2304.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 20, 2005

Volume

46

Issue

12

Start / End Page

2298 / 2304

Location

United States

Related Subject Headings

  • Walking
  • Treatment Outcome
  • Time Factors
  • Severity of Illness Index
  • Quality of Life
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • Female