Document Detail

Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure.
MedLine Citation:
PMID:  16360062     Owner:  NLM     Status:  MEDLINE    
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.
Angel R León; William T Abraham; Susan Brozena; James P Daubert; Westby G Fisher; John C Gurley; Chang Seng Liang; George Wong;
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  46     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-19     Completed Date:  2006-03-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2298-304     Citation Subset:  AIM; IM    
Carlyle Fraser Heart Center/Division of Cardiology, Emory University, Atlanta, Georgia, USA.
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MeSH Terms
Cardiac Output, Low / diagnosis,  physiopathology*,  therapy*
Cardiac Pacing, Artificial / methods*
Middle Aged
Quality of Life
Severity of Illness Index
Time Factors
Treatment Outcome

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