A pilot experience with permanent biventricular pacing to treat advanced heart failure

Background The prognosis and quality of life of patients With advanced hear t failure remain poor. The purpose of this study was to evaluate new nonpha rmacologic approaches. Biventricular pacing was proposed in this indication , based on the encouraging results of acute hemodynamics studies. Methods Fifty patients with drug-resistant heart failure (New York Heart As sociation [NYHA] class III/IV, 16 of 34) were consecutively implanted with biventricular pacemakers. All patients had severe dilated cardiomyopathy an d intraventricular conduction delay. Survivor, NYHA class, electrocardiogra m, echocardiographic data, and exercise tolerance were assessed over a mean follow-vp period of 15.4 +/- 10.2 months. Results At the end of follow-up, 55% of patients were olive without heart t ransplantation or left ventricular assistance device. The mortality rate wa s significantly lower in class III (12.5%) than in class IV patients (52.5% ). In survivors, biventricular pacing significantly improved symptoms (NYHA class 2.2 +/- 0.5 at follow-up vs 3.7 +/- 0.5 at baseline) and exercise to lerance (Vo(2) peak 15.5 +/- 3.4 mL/min per kilogram at follow-up vs 11.1 /- 3 mL/min per kilogram at baseline). Conclusions Biventricular pacing appears to improve the functional status o f patients with dilated cardiomyopathy with advanced heart failure. The tec hnique appears to be attractive as an additive treatment, especially in cla ss III patients. Controlled randomized studies are needed to validate this novel concept.