Biventricular pacing in patients candidate to an ICD

Biventricular pacing can improve cardiac performance in patients with conge stive heart failure and interventricular conduction delay. Despite haemodyn amic improvement, the mortality rate in these patients is still high and su dden deaths account for up to half of the total mortality. Biventricular pa cing with implantable cardioverter defibrillator (ICD) back-up is now being evaluated clinically to estimate the improvement in cardiac performance an d decrease of mortality due to ventricular tachyarrhythmias. After the first implantable cardioverter defibrillator implant with biventr icular pacing performed in August 1998 in Asti, 48 patients with congestive heart failure (NYHA II-IV) and sustained ventricular tachycardia or ventri cular fibrillation underwent implant of biventricular implantable cardiover ter defibrillator in five Italian centres over a 22-month period. The mean age (+/- SD) was 63 +/- 7 years, QRS width was greater than or equal to 140 ms and left ventricular ejection fraction <35%. At implant, R wave amplitu de and pacing thresholds were 14.1 +/- 5.7 mV and 0.8 +/- 0.5 V for the rig ht ventricle, and 13 +/- 8.1 mV and 1 +/- 0.8 V for the left ventricle resp ectively. The mean QRS width decreased from 173 +/- 26 ms to 156 +/- 25 ms with biventricular pacing (P<0.05). No major complications occurred. During follow-up of 228 +/- 153 days, six (12.5%) patients died: three (6%) from pump failure, one (2%) for electromechanical dissociation and two (4%) for non-cardiac causes. Two patients (4%) had coronary sinus lead dislodgement, 17 patients (35%) had implantable cardioverter defibrillator intervention with shock. Functional NYHA class improved from 2.9 +/- 0.6 to 1.7 +/- 0.5. These preliminary data demonstrate the feasibility of implantable cardiover ter defibrillator implant with biventricular pacing and the efficacy in imp roving cardiac performance and treating ventricular tachyarrhythmias in pat ients with congestive heart failure and sustained ventricular tachycardia o r ventricular fibrillation. (Eur Heart J Supplements 2000; 2 (Suppl J): J36 -J40) (C) 2000 The European Society of Cardiology.