C. Leclercq et al., Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure, J AM COL C, 32(7), 1998, pp. 1825-1831
Citations number
22
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives. The aim of this study was to assess the potential acute benefit
of multisite cardiac pacing with optimized atrioventricular synchrony and
simultaneous biventricular pacing in patients with drug-refractory congesti
ve heart failure (CHF).
Background. Prognosis and quality of life in severe CHF are poor. Various n
onpharmacological therapies have been evaluated but are restricted in their
effectiveness and applications. In the early 1990s, dual chamber pacing (D
DD) pacing was proposed as primary treatment of refractory CHF but results
mere controversial. Recently, tests to evaluate the effect of simultaneous
pacing of both ventricles have elicited a significant improvement of cardia
c performance.
Methods. Acute hemodynamic study was conducted in 18 patients with severe C
HF (New York Heart Association class III and IV) and major intraventricular
conduction block (IVCB) (QRS duration = 170 +/- 37 ms). Using a Swan-Ganz
catheter, pulmonary artery pressure, pulmonary capillary wedge pressure (PC
WP) and cardiac index (CI) were measured in different pacing configurations
: atrial pacing (AAI) mode, used as reference, single site right ventricula
r DDD pacing and biventricular pacing with the right ventricular lead place
d either at the apex or at the outflow tract.
Results. The CI was significantly increased by biventricular pacing in comp
arison with AAI or right ventricular (RV), DDD pacing (2.7 +/- 0.7 vs. 2 +/
- 0.5 and 2.4 +/- 0.6 l/min/m(2), p < 0.001). The PCWP also decreased signi
ficantly during biventricular pacing, compared with AAI (22 +/- 8 vs. 27 +/
- 9 mm Hg; p < 0.001).
Conclusions. This acute hemodynamic study demonstrated that biventricular D
DD pacing may significantly improve cardiac performance in patients with IV
CB and with severe heart failure, in comparison,vith intrinsic conduction a
nd single site RV DDD pacing. (J Am Coll Cardiol 1998;32:1825-31) (C)1998 b
y the American College of Cardiology.