Potential benefit of biventricular pacing in patients with congestive heart failure and ventricular tachyarrhythmia

Treatment of congestive heart failure (CHF) aims for symptomatic relief and reduction of mortality both from sudden death and pump failure. The implan table cardioverter defibrillator (ICD) is highly effective in the preventio n of sudden death, but no mortality benefit in advanced CHF has yet been sh own. Biventricular pacing may lead to functional improvement in selected pa tients with CHF. Thus, a biventricular pacemaker with defibrillation capabi lities may be ideal for patients with advanced CHF. We retrospectively anal yzed the data from 384 patients (age 59 +/- 12 years, 322 male and 62 femal e) with regard to New York Heart Association (NYHA) CHF class, mean QRS dur ation, mean PR interval, presence of a QRS >120 msec and incidence of atria l fibrillation at the time of ICD implantation. Based on eligibility criter ia from studies in biventricular pacing, we analyzed how many patients may benefit from biventricular pacing, Patients with CHF were older (NYHA class III: 60.9 +/- 9.7, class II: 61.3 +/- 10 versus class I: 50.8 +/- 73.6 yea rs, p < 0.001 each)and mean QRS duration was longer with advanced CHF (NYHA class III 127.8 +/- 30 msec; class II 119.4 +/- 27.7 msec; class 0-I: 103. 9 +/- 17.7 msec, p < 0.001, analysis of variance) as wets the mean PR inter val (NYHA class III 189.9 +/- 33.5 msec; class II 176.1 +/- 29.3 msec; clas s 0-I 162.7 +/- 45.9 msec, p < 0.001, analysis of variance). The incidence of atrial fibrillation was higher in class III (25.5%) compared with class 0-I (16.9%) and class II patients (14.1%, p = 0.043, chi-square test). A to tal of 28 patients (7.3%) fulfilled eligibility criteria for biventricular pacing if NYHA class III patients were considered candidates and 48 (12.5%) if patients with NYHA II CHF and ejection fraction less than or equal to 3 0% were included. Thus, biventricular pacing may offer a promising therapeu tic approach for a significant proportion of patients with CHF at risk for ventricular tachyarrhythmia. (C) 1999 by Excerpta Medica., Inc.