Left ventricular-based pacing in patients with chronic heart failure: comparison of acute hemodynamic benefits according to underlying heart disease

Background: Acute left ventricular-based pacing has been shown to improve h emodynamics in patients with severe heart failure and left bundle branch bl ock (LBBB). However, it is not known whether the cause of the underlying he art disease influences the potential effect of left ventricular-based pacin g. Objectives: The aim of this study was to determine whether beneficial he modynamic effects of acute left ventricular-based pacing in severe chronic heart failure are dependent on underlying heart disease. Methods: After cor onary angiography, patients with severe heart failure and LBBB were separat ed into two groups: dilated (25 patients; 20 male) and ischemic cardiomyopa thy (21 patients; 20 male). Hemodynamic parameters were evaluated at baseli ne and during left ventricular-based pacing. Results: Improvement in hemody namic parameters were similar in both groups, during acute left ventricular pacing (changes expressed in percentage): pulmonary capillary wedge pressu re, -16 +/- 15% vs. -14 +/- 10%; V wave amplitude, -25 +/- 18% vs. -21 +/- 17%; and biventricular pacing, -15 +/- 15% vs. -11 +/- 11% and -23 +/- 18% vs. -16 +/- 18%, respectively. Conclusion: Underlying heart disease does no t influence the response to acute left ventricular-based pacing in patients with severe heart failure and LBBB. This finding provides support for incl uding all patients with enlarged heart and heart failure in future studies evaluating left ventricular-based pacing. (C) 2000 European Society of Card iology. All rights reserved.