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CRT improves left ventricular performance and functional status in patients with permanent atrial fibrillation and prior remote right ventricular pacing.

Background: Acute left ventricular-based pacing has been shown to improve hemodynamics in patients with severe heart Ž . failure and left bundle branch block LBBB . However, it is not known whether the cause of the underlying heart disease influences the potential effect of left ventricular-based pacing. Objecti¨es: The aim of this study was to determine whether beneficial hemodynamic effects of acute left ventricular-based pacing in severe chronic heart failure are dependent on underlying heart disease. Methods: After coronary angiography, patients with severe heart failure and LBBB were separated Ž . Ž . into two groups: dilated 25 patients; 20 male and ischemic cardiomyopathy 21 patients; 20 male . Hemodynamic parameters were evaluated at baseline and during left ventricular-based pacing. Results: Improvement in hemodynamic parameters were Ž . similar in both groups, during acute left ventricular pacing changes expressed in percentage : pulmonary capillary wedge pressure, y16 " 15% vs. y14 " 10%; V wave amplitude, y25 " 18% vs. y21 " 17%; and biventricular pacing, y15 " 15% vs. y11 " 11% and y23 " 18% vs. y16 " 18%, respectively. Conclusion: Underlying heart disease does not influence the response to acute left ventricular-based pacing in patients with severe heart failure and LBBB. This finding provides support for including all patients with enlarged heart and heart failure in future studies evaluating left ventricular-based pacing.

Placement of a permanent lead in a tributary of the coronary sinus is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasizes the need for development of specially designed leads for this application.

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