Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF): a prospective multicentre randomized controlled trial of triventricular pacing vs. conventional biventricular pacing in patients with heart failure and intermediate QRS left bundle branch block

Justin Gould, Simon Claridge, Thomas Jackson, Benjamin J Sieniewicz, Baldeep S Sidhu, Bradley Porter, Mark K Elliott, Vishal Mehta, Steven Niederer, Humra Chadwick, Ravi Kamdar, Shaumik Adhya, Nikhil Patel, Shoaib Hamid, Dominic Rogers, William Nicolson, Cheuk F Chan, Zachary Whinnett, Francis Murgatroyd, Pier D Lambiase, Christopher A Rinaldi, Justin Gould, Simon Claridge, Thomas Jackson, Benjamin J Sieniewicz, Baldeep S Sidhu, Bradley Porter, Mark K Elliott, Vishal Mehta, Steven Niederer, Humra Chadwick, Ravi Kamdar, Shaumik Adhya, Nikhil Patel, Shoaib Hamid, Dominic Rogers, William Nicolson, Cheuk F Chan, Zachary Whinnett, Francis Murgatroyd, Pier D Lambiase, Christopher A Rinaldi

Abstract

Aims: To determine whether triventricular (TriV) pacing is feasible and improves CRT response compared to conventional biventricular (BiV) pacing in patients with left bundle branch block (LBBB) and intermediate QRS prolongation (120-150 ms).

Methods and results: Between October 2015 and November 2019, 99 patients were recruited from 11 UK centres. Ninety-five patients were randomized 1:1 to receive TriV or BiV pacing systems. The primary endpoint was feasibility of TriV pacing. Secondary endpoints assessed symptomatic and remodelling response to CRT. Baseline characteristics were balanced between groups. In the TriV group, 43/46 (93.5%) patients underwent successful implantation vs. 47/49 (95.9%) in the BiV group. Feasibility of maintaining CRT at 6 months was similar in the TriV vs. BiV group (90.0% vs. 97.7%, P = 0.191). All-cause mortality was similar between TriV vs. BiV groups (4.3% vs. 8.2%, P = 0.678). There were no significant differences in echocardiographic LV volumes or clinical composite scores from baseline to 6-month follow-up between groups.

Conclusion: Implantation of two LV leads to deliver and maintain TriV pacing at 6 months is feasible without significant complications in the majority of patients. There was no evidence that TriV pacing improves CRT response or provides additional clinical benefit to patients with LBBB and intermediate QRS prolongation and cannot be recommended in this patient group.

Clinical trial registration number: Clinicaltrials.gov: NCT02529410.

Keywords: Cardiac resynchronization therapy; Improving cardiac resynchronization therapy response; Multi-lead left ventricular pacing; Multi-site pacing; Triventricular pacing.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Figure 1
Figure 1
Representative posterior–anterior (A) and lateral (B) chest radiographs 1-day post-implantation showing a triventricular cardiac resynchronization therapy-defibrillator. Left ventricular leads are located in posterolateral and lateral coronary veins.
Figure 2
Figure 2
Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF) CONSORT flow diagram. CONSORT diagram adapted from Schulz et al. LV, left ventricular.
Figure 3
Figure 3
Pie charts showing the distribution of final primary (A) and secondary (B) left ventricular lead locations in the TriV group and in the biventricular group (C) determined by coronary venous anatomy. LV, left ventricular.
Figure 4
Figure 4
Box and whisker plots comparing echocardiographic and clinical measures at baseline and 6-month follow-up for both groups. A) Left ventricular end-systolic volume, B) Left ventricular ejection fraction, C) NT-proBNP, D) MLWHFQ score, E) 6MWT distance, F) NYHA functional class. LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; MLWHFQ, Minnesota living with heart failure questionnaire; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; 6MWT, 6-min walk test.
Figure 5
Figure 5
Cardiac resynchronization therapy volumetric response outcomes by heart failure aetiology within triventricular and biventricular groups. aVolumetric response defined as ≥15% reduction in left ventricular end-systolic volume on two-dimensional echocardiography. BiV, biventricular; TriV, triventricular.

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Source: PubMed

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