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17.03.2020 | Ausgabe 2/2021

Journal of Interventional Cardiac Electrophysiology 2/2021

Single- and multi-site pacing strategies for optimal cardiac resynchronization therapy: impact on device longevity and therapy cost

Zeitschrift:
Journal of Interventional Cardiac Electrophysiology > Ausgabe 2/2021
Autoren:
Antonio D’Onofrio, Matteo Bertini, Tommaso Infusino, Girolamo D’Arienzo, Laura Cipolletta, Valter Bianchi, Giovanni Licciardello, Gianluca Savarese, Giovanni Russo, Danilo Ricciardi, Michele Manzo, Francesca Fabbri, Pasquale Notarstefano, Luca Santini, Monica Campari, Sergio Valsecchi, Giovanni Battista Forleo
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10840-020-00711-3) contains supplementary material, which is available to authorized users.

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Abstract

Background

Multiple left ventricular pacing strategies have been suggested for improving response to cardiac resynchronization therapy (CRT). However, these programming strategies may sometimes entail accepting configurations with high pacing threshold and accelerated battery drain. We assessed the feasibility of predefined pacing programming protocols, and we evaluated their impact on device longevity and their cost-impact.

Methods

We estimated battery longevity in 167 CRT-D patients based on measured pacing parameters according to multiple alternative programming strategies: single-site pacing associated with lowest threshold, non-apical location, longest interventricular delay, and pacing from two electrodes. To determine the economic impact of each programming strategy, we applied the results of a model-based cost analysis using a 15-year time horizon.

Results

Selecting the electrode with the lowest threshold resulted in a median device longevity of 11.5 years. Non-apical pacing and interventricular delay maximization were feasible in most patients and were obtained at the price of a few months of battery life. Device longevity of > 10 years was preserved in 87% of cases of non-apical pacing and in 77% on pacing at the longest interventricular delay. The mean reduction in battery life when the second electrode was activated was 1.5 years. Single-site pacing strategies increased the therapy cost by 4–6%, and multi-site pacing by 12–13%, in comparison with the lowest-cost scenario.

Conclusions

Modern CRT-D systems ensure effective pacing and allow multiple optimization strategies for maximizing service life or for enhancing effectiveness. Single- or multi-site pacing strategies can be implemented without compromising device service life and at an acceptable increase in therapy cost.

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