How many people with heart failure are appropriate for biventricular resynchronization?

Aims Increasing evidence exists suggesting that biventricular pacing improv es outcome and symptoms in severe heart failure if various selection criter ia are fulfilled. It is unsure how many people might benefit from this ther apy. Our aim was to provide such data. Methods and Results Over one calendar year all patients admitted to a large U.K. District General Hospital, that were classified with a diagnosis of h eart failure, were audited. The selection criteria were: (1) severe heart f ailure (NYHA class III or IV), (2) heart failure due to a dilated cardiomyo pathy, (3) QRS duration greater than 120 ms or (4) the presence of a bundle branch block pattern. Subjects were divided into those in sinus rhythm to determine those who would be suitable for atrially synchronized biventricul ar pacing and those with an abnormally long PR interval (>210 ms) who might additionally benefit from improved atrioventricular synchrony. 1042 patien ts were coded with heart failure. 721 fulfilled diagnostic criteria and, we re studied. 202 (28%) had severe heart failure, 178 (25%) had a ORS of at l east 120 ms, 437 (61%) had an ischaemic cardiomyopathy, 176 (24%) an idiopa thic cardiomyopathy and 433 (60%) were in sinus rhythm. Overall mortality a t the time of census was 29%. 43 patients were suitable for biventricular p acing with a further 29 atrial patients fibrillation who might benefit from biventricular pacing alone. Conclusion Using our criteria, approximately 10% of an unselected group of heart failure admitted to a typical U.K. district general hospital over a c alendar year would be appropriate for biventricular pacing. This represents a large number of patients who might derive benefit from this new therapy. (Eur Heart J 2000; 21: 1246-1250). (C) 2000 The European Society of Cardio logy.