Mid-term follow-up of endocardial biventricular pacing

Biventricular (BV) pacing is a promising treatment of end-stage heart failu re. This article describes our experience with a strictly endocardial BV pa cing system in patients with severe congestive heart failure. Three women a nd eight men (age 65 +/- 9 years) with drug-resistant end-stage CHF underwe nt implantation of an endocardial BV pacing system. In the first seven pati ents, the left ventricular lead was placed via a combined femoral and inter nal jugular approach. In the last four patients, the transseptal puncture w as directly performed via the right internal jugular vein with a dedicated kit. The procedure was successful in all 11 patients. The acute left ventri cular and BV thresholds were 1.3 +/- 0.6 V and 2.4 +/- 1 V, respectively. T he QRS duration decreased from 214 +/- 57 to 176 +/- 25 ms. A functional im provement was noted in ten patients with a decrease in mean NYHA functional class from 3.7 +/- 0.5 before, to 2.6 +/- 0.9 after system implantation. A significant decrease in pulmonary capillary wedge pressure and increase in cardiac output were measured in eight patients. During follow-up, four pat ients died from CHF (n = 3) or ventricular fibrillation (n = 1). Under oral anticoagulation, no thromboembolic event wets observed but one transient i schemic attack occurred in one patient whose anticoagulation was interrupte d. Endocardial BV pacing is technically feasible and appears safe, though f urther studies are needed before it is used on a larger scale.