Antiarrhythmic Effect of Cardiac Resynchronization Therapy with Triple-Site Biventricular Stimulation

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Background: Cardiac resynchronization therapy (CRT) with a single RV and LV lead (CRT with 2V) includes proarrhythmic effect from an increase the transmural dispersion of repolarization, and antiarrhythmic effect from ventricular reverse remodeling. CRT with triple-site biventricular stimulation with a single RV and two LV leads (CRT with 3V) might reduce the ventricular arrhythmias (VAs). Methods: The study included 55 patients with a CRT defibrillator. Prior to implantation, acute hemodynamic effect of CRT with 2V and 3V were measured by an invasive electrophysiologic study and 3V was introduced when better response was achieved. Spontaneous VAs detected by the device were reviewed with a follow-up of 12 months. Results: Hemodynamic study indicated 19 patients (34.5%) eligible for CRT with 3V. At 12 months follow up, 15 patients (27.2%) experienced VAs. We developed logistic regression model to identify variables associated with risk of VAs. Reduction rate of LV end-systolic volume were identified between CRT with 2V and 3V (18.8±34.0% vs. 16.3±25.1% p=0.52). Nonetheless, CRT with 3V showed a significant reduction in VAs (odds ratio 0.095, 95 percent confidence interval 0.084 to 0.108; p=0.01). Conclusions: CRT with 3V was associated with a reduction in VAs independent of LV reverse remodeling.