Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure: A meta-analysis of randomized and observational studies.

BACKGROUND

Conventional cardiac resynchronization therapy (CRT, Bi-V) is associated with no response in about 40% patients due to an insufficient resynchronization. Some studies showed triple-site ventricular (Tri-V) pacing had greater benefits compared with Bi-V pacing, but the results of these studies were conflicting. We hypothesized that Tri-V pacing had greater benefits on long-term outcomes compared with Bi-V pacing in patients with heart failure.

METHODS

PubMed, EMBASE, and the Cochrane Library were searched for clinical studies with related outcomes. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated to compare the change in left ventricular ejection fraction (LVEF), left ventricular geometry, functional capacity, and quality of life between Tri-V pacing group and control group.

RESULTS

Five trials with 251 patients were included in the analysis. Patients in the Tri-V pacing group had a greater improvement in LVEF (WMD 4.04; 95% CI 2.15-5.92,  < .001) and NYHA classes (WMD -0.27; 95% CI -0.42 to -0.11,  = .001) compared with control group. However, there were no significant differences in left ventricular geometry, six-min walk distance, or Minnesota Living With Heart Failure Questionnaire score between the two groups. The subgroup analyses showed there might be a greater improvement in LVEF in the Tri-V pacing group in patients with QRS duration ≥ 155 ms (WMD 5.60; 95% CI 3.09-8.10,  < .001).

CONCLUSIONS

The present analysis suggests that Tri-V pacing has greater benefits in terms of an improvement in LVEF and functional capacity in patients with systolic heart failure, especially in patients with the duration of QRS ≥ 155 ms.