"Paced or Sensed Conduction Time to Determine programming with Cardiac Resynchronization Therapy: The PASED-CRT Trial".

Background Cardiac resynchronization therapy (CRT) is a well-established treatment for patients with drug refractory heart failure OBJECTIVES: This study sought to compare the longest RVsense to LVsense activation time (sLAT) versus the longest RVpace to LVsense activation time (pLAT) as the programmed site for LV pacing in CRT patients with quadripolar LV leads at 3 months. Methods This single site, double-blinded, prospective trial, randomized patients 1:1 into the sLAT or pLAT group to determine response. Left ventricular pacing was programmed at implant and maintained thru 3 months of follow-up. The 6-minute hall walk test (6MHW), NYHA, MLWHF, and Clinical Composite Score (CCS) at the 3-months was compared. Results N = 92 patients (73M:19F age 66 ±11.3 years) were randomized implanted and programmed per protocol. Baseline characteristics were comparable. N = 39 sLAT and N = 34 pLAT completed the 3-month visit for final analysis. Significant improvement from baseline to 3 months was seen in the sLAT group from 253.9(+/-11.5) to 323.1(+/-11.9) P = 0.001 Similarly, the pLAT group improved from 274.9 (+/-16.15) to 343.9 (+/-15.9) p = 0.003. The difference between these groups however did not reach significance. (P = 0.86) The pLAT group demonstrated a higher responder rate of (71%) versus the sLAT group (64%) based on the CCS although not reaching significance (P = 0.56) CONCLUSIONS: Use of both the pLAT and sLAT method of programming demonstrated significant improvement in 6MHW distance at 3 months with pLAT demonstrating a slightly higher responder rate based on CCS (P = 0.56). pLAT should be considered at minimum as equivalent in patients with no intrinsic conduction. This article is protected by copyright. All rights reserved.