Jc. Pachon et al., Ventricular endocardial right bifocal stimulation in the treatment of severe dilated cardiomyopathy heart failure with wide QRS, PACE, 24(9), 2001, pp. 1369-1376
Citations number
18
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
The QRS widening by ventricular conventional pacing impairs the systolic an
d diastolic functions and increases mitral regurgitation. The aim of this s
tudy was to compare conventional pacing to an alternative stimulation mode
with a narrower QRS using two leads in the RV. Thirty-nine (25 men, 14 wome
n; mean age 60,1 +/- 15.1 years) dilated cardiomyopathy patients (Chagas' d
isease fn = 17], coronariopathy [n = 9], AV ablation for tachycardiomyopath
y [n = 3], and other [n = 10]) with cardiac failure (NYHA 3,1 +/- 0.8), pac
emaker indication, and chronic AV block (22 AF) had endocardial pacemaker i
mplantations (27 Biotronik, 12 Guidant). Two RV leads (one septa], one conv
entional [RV apex] were connected, respectively, to the atria] and ventricu
lar pacemaker plugs. After clinical stabilization they were studied under t
hree stimulation modes in the same session: AAI (septal), VVI (conventional
), and ventricular endocardial right bifocal stimulation (VERBS) (DDT/DVI/D
DD = AV interval = 15/10 ms). In comparison to conventional pacing, VERBS i
ncreased ejection fraction (0,124), cardiac output (19,5%), and peak fillin
g rate (31.0%), and decreased QRS duration (24.7%), left atrium area (11.9%
), mitral regurgitation area (32.3%), the diastolic transmitral flow (EIA r
elation) (19.3%), and the propagation flow time (18.0%) from the mitral val
ve to the left ventricular apex (tE_col), (P < 0.05). The quality-of-life s
howed an impressive score reduction of 50.4%. The septa] stimulation alone
showed a less expressive benefit. In severe dilated cardiomyopathy with cla
ssic pacemaker indication, VERBS showed significantly better performance th
an the septal or the conventional stimulation alone. There was a good systo
lic and a remarkable diastolic improvement causing an important reduction i
n the quality-of-life score.