Cardiac Resynchronization Therapy Clinical Trial
Official title:
Prospective Randomized Trial Comparing TRIPLE Site ventriculAr Stimulation Versus Conventional Pacing in CRT canDidates: TRIPLEAD Trial
Cardiac resynchronization therapy (CRT) is a recommended treatment for selected patients with
symptomatic heart failure (HF). Although most treated patients show a benefit from CRT, a
lack of response is observed for about 25-30% of them whatever the response criteria used
either based on the clinical status (NYHA class, Packer clinical composite score) or on
ventricular remodeling parameters assessed by echography (Left ventricle end of systole
volume). This rate has remained remarkably stable since the therapy started and has motivated
many studies to better understand the underlying physiopathology and the CRT action
mechanisms.
Among the various research axes to improve CRT response and responders rate, increasing the
number of pacing sites in an attempt to better homogenize the cardiac mechanical activity has
been evaluated. A configuration with two RV leads and one LV lead was tested acutely in three
studies. In all cases, it demonstrated a significant improvement of cardiac performance
whether assessed by echographic parameters or LV dp/dt measurements. Additionally feasibility
of this approach for long term CRT delivery was demonstrated during a previous study. First
results with triple-site ventricular stimulation are encouraging and its clinical efficacy
should now be tested on a larger population in order to conclude on its interest for CRT
candidates.
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