Multisite cardiac resynchronization therapy for traditional and non-traditional indications

J Interv Card Electrophysiol. 2018 Mar;51(2):143-152. doi: 10.1007/s10840-018-0316-4. Epub 2018 Feb 13.


Purpose: Multisite cardiac resynchronization therapy (MSCRT) with dual-vein left ventricular (LV) pacing has theoretical advantages over conventional CRT in faster and more physiological LV activation. We aimed to define indications, feasibility, safety, acute, and long-term results of MSCRT.

Methods: All patients implanted with MSCRT during 2008-2014 in a single center were reviewed and analyzed.

Results: Thirty-nine patients (90% CRT-defibrillators, 64 ± 9 years, 85% male, 74% ischemic etiology) were included. Four groups of indications were recognized: (1) significant tricuspid regurgitation (TR) in patients planned for device implantation without right ventricular lead (n = 3). Follow-up (f/u) of 4 ± 3 years showed major symptomatic improvement in all, with stable LV size and function and deferral of valve surgery; (2) severe heart failure with reduced ejection fraction (HFrEF) and refractory ventricular tachycardia (VT) (n = 4). Except for 1 early death for acute renal failure, all others showed no VT episodes and HF improvement (f/u 4.5 ± 0.5 years); (3) severe HFrEF and wide QRS (≥ 150 ms) or failure of biventricular pacing to narrow QRS during implantation (n = 5). One patient had periprocedural mortality. The others had major clinical improvement; (4) severe HF and narrow QRS/RBBB (n = 27). 23/24 patients with available f/u of 3 ± 1.7 years improved clinically and 57% had EF improvement. In 3 patients, LV1 was disabled and one had LV2 dislodgement.

Conclusions: MSCRT is feasible, safe, and valuable in selected patients with a need to avoid RV lead during device implantation, refractory VT with no other solution, severe HFrEF with wide QRS or CRT non-responsiveness, and severe HF without LBBB. Randomized controlled studies are required.

Keywords: Feasibility; Heart failure; Indications; Multisite cardiac resynchronization therapy; Safety.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cardiac Pacing, Artificial / methods
  • Cardiac Pacing, Artificial / mortality
  • Cardiac Resynchronization Therapy / methods*
  • Cardiac Resynchronization Therapy / mortality
  • Echocardiography, Transesophageal / methods*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnostic imaging*
  • Heart Failure / mortality
  • Heart Failure / therapy*
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial
  • Patient Selection
  • Recovery of Function
  • Recurrence
  • Registries*
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate
  • Treatment Outcome