In refractory heart failure, biventricular pacing improves prognosis and quality of life by reversing the left ventricular (LV) remodeling. We tested the hypothesis that triventricular pacing (TriV, 2 leads in the right ventricle and 1 lead in the coronary sinus) would better improve LV volume and function that does biventricular pacing (BiV).

15 consecutive heart failure patients (ischemic n=10 and non ischemic heart disease n=5) meeting the European criteria for cardiac resynchronization were imaged from 1 apical 3D acquisition in conventional and tissue Doppler modality (Vivid 7, GE Healthcare). LV volumes, EF and standard deviation in time to peak systolic velocity (modified Yu criteria from 6 segments) were measured before implantation and at 3-month F/U in triventricular and biventricular septal pacing. By ANOVA, biventricular septal pacing reduced LV volumes and improved EF compared to baseline (see figure). The additional significant EF enhancement found with triventricular configuration (p<0.05, see figure) was due to better tissue Doppler imaging synchronization (Standard deviation was 44±20ms, 36±12ms and 28±15ms at baseline, biventricular and triventricular configuration, respectively, p=0.01). We found a negative linear correlation between EF and the tissue Doppler imaging standard deviation (y =-0.5×+50.3, r=0.36, p<0.03)

In this pilot study, triventricular pacing demonstrates superior left ventricular reverse remodeling and intraventricular coordination than does biventricular pacing in patients with refractory heart failure.