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

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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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Author information

Authors and Affiliations

  1. Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Azienda Ospedaliera dei Colli – Monaldi, Via Leonardo Bianchi, 1, 80131, Naples, Italy

    Antonio D’Onofrio & Valter Bianchi

  2. S. Anna University Hospital, Ferrara, Italy

    Matteo Bertini

  3. S. Anna Hospital, Catanzaro, Italy

    Tommaso Infusino

  4. Ospedali Riuniti University Hospital, Foggia, Italy

    Girolamo D’Arienzo

  5. Marche Polytechnic University, Ancona, Italy

    Laura Cipolletta

  6. Ospedale E. Muscatello, Augusta, Italy

    Giovanni Licciardello

  7. Ospedale S. Giovanni Battista, Foligno, Italy

    Gianluca Savarese

  8. Ospedale San Leonardo, Castellammare di Stabia, Naples, Italy

    Giovanni Russo

  9. Campus Biomedico, Roma, Italy

    Danilo Ricciardi

  10. Ospedali Riuniti San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

    Michele Manzo

  11. Ospedale Infermi, Rimini, Italy

    Francesca Fabbri

  12. Ospedale S. Donato, Arezzo, Italy

    Pasquale Notarstefano

  13. Ospedale Giovan Battista Grassi, Ostia lido, Rome, Italy

    Luca Santini

  14. Boston Scientific, Milan, Italy

    Monica Campari & Sergio Valsecchi

  15. Ospedale Luigi Sacco, Milan, Italy

    Giovanni Battista Forleo

Authors
  1. Antonio D’Onofrio
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  2. Matteo Bertini
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Corresponding author

Correspondence to Antonio D’Onofrio.

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M. Campari and S. Valsecchi are employees of Boston Scientific, Inc. No other conflicts of interest exist.

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Appendix

Appendix

1.1 List of participating centers and investigators

AORN - OSPEDALE DEI COLLI - P.O. MONALDI - NAPOLI: A. D’Onofrio, V. Bianchi, V. Tavoletta; ARCISPEDALE S. ANNA - FERRARA: M. bertini, M. Malagù; OSPEDALE S. ANNA - CATANZARO: T. Infusino; OSPEDALI RIUNITI DI FOGGIA - FOGGIA: G. D’Arienzo, L. C. Ziccardi, A. Nardella, R. Petrucci, L. D’Arienzo, A. Ricco; AOU RIUNITI - TORRETTE DI ANCONA: A. Capucci, L. Cipolletta, M. Luzi; P.O. MUSCATELLO - AUGUSTA (SR): G. Licciardello, G. Busacca; OSPEDALE SAN GIOVANNI BATTISTA - FOLIGNO: G. Savarese, C. Andreoli; OSPEDALE S. LEONARDO - CASTELLAMMARE DI STABIA (NA): G. Russo, S. Mennella, R. Chianese, E. Zingone; CAMPUS BIOMEDICO - ROMA: D. Ricciardi, V. Calabrese; A.O. UNIVERSITARIA S. GIOVANNI DI DIO E RUGGI D’ARAGONA - SALERNO: M. Manzo, C. Esposito, F. Esposito, D. Ferraioli, F. Franculli; OSPEDALE INFERMI - RIMINI: F. Fabbri, D. Saporito; P.O. ZONA ARETINA OSPEDALE S. DONATO - AREZZO (AR): P. Notarstefano, M. Nesti, A. Fraticelli, R. Guida, A. Fabiani; OSPEDALE G.B. GRASSI - OSTIA (RM): L. Santini, F. Ammirati, K. Mahfouz, V. Schirripa; CLINICA MEDITERRANEA S.P.A. - NAPOLI: G. Stabile, A. Iuliano; OSPEDALE CIVILE DI VOGHERA - VOGHERA: P. Broglia, C. Bosatra; OSPEDALE VITO FAZZI - LECCE: E. Pisanò; NUOVO OSPEDALE S. STEFANO - PRATO: T. Giovannini, F. Frascarelli; OSPEDALE CIVILE CIVITANOVA MARCHE (MC): D. Spagnolo; AZIENDA UNIVERSITARIA POLICLINICO UMBERTO I - ROMA: A. Piro, C. Lavalle; OSPEDALE SS.TRINITA’ - BORGOMANERO: S. Maffé; OSPEDALE G. PANICO - TRICASE: P. Palmisano, M. Accogli; CLINICA MONTEVERGINE - MERCOGLIANO (AV): F. Solimene; OSPEDALE SACCO - MILANO: G.B. Forleo, L. Lombardi; Ospedale S. CROCE e CARLE - CUNEO: E. Menardi; OSPEDALE CAMPO MARTE - LUCCA: D. Giorgi.

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D’Onofrio, A., Bertini, M., Infusino, T. et al. Single- and multi-site pacing strategies for optimal cardiac resynchronization therapy: impact on device longevity and therapy cost. J Interv Card Electrophysiol 60, 195–203 (2021). https://doi.org/10.1007/s10840-020-00711-3

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  • DOI: https://doi.org/10.1007/s10840-020-00711-3

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