Multisite Pacing for End‐Stage Heart Failure: Early Experience

Abstract

Our objective was to improve hemodynamics by synchronous right and left site ventricular pacing in patients with severe congestive heart failure (CHF). Previous studies reported a benefit of dual chamber pacing with a short AV delay in patients with severe CHF. Other works, however, show contradictory results. Deleterious effects due to a desynchronization of right (RV) and left ventricular (LV) contractions have been suggested. This study included eight subjects with widened QRS and end-stage heart failure despite maximal medical therapy, who refused, or were not eligible to undergo heart transplantation, Each patient underwent a baseline, invasive hemodynamic evaluation with insertion of three temporary leads to allow different pacing configurations, including RV apex and outflow tract pacing, and biventricular pacing between the RV outflow tract and LV and RV apex and LV. According to the results of this baseline study, the configuration of preexistent pacemakers was modified or new systems were implanted to allow biventricular pacing, which, in patients with sinus rhythm, was atrial triggered. Biventricular pacing increased the mean cardiac index (CI) by 25% (from a baseline of 1.83 +/- 0.30 L/min per m2, P < 0.006), decreased the mean V wave by 26% (from a baseline of 36 +/- 12 mmHg, P < 0.004), and decreased pulmonary capillary wedge pressure by 17% (from a baseline of 31 +/- 10 mmHg, P < 0.01). Four patients died (1 preoperatively, 1 intraoperatively, 2 within 3 months, and 1 of a noncardiac cause). The four surviving patients have clinically improved from New York Heart Association Functional Class IV to Class II. In these survivors, CI decreased by 15% (P < 0.007) when multisite pacing was turned off during follow-up. In patients with end-stage heart failure, multisite pacing may be associated with a rapid and sustained hemodynamic improvement.

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

“…[1][2][3][4][5] By providing early stimulation to the otherwise late-activated region, pacing probably improves contractile coordination to enhance ejection. However, the therapy involves an implantable device, making it important to identify patients most likely to benefit.…”

Permanent biventricular ICD-implantation in a heart failure second re-do-CABG patient: a case report

“…Various studies have demonstrated efficacy of biventricular pacing in advanced heart failure [2,3,7]. The acute hemodynamic improvement was also observed in the immediate postoperative course in patients undergoing open heart surgery with impaired left ventricular function [4-6].…”

“…In these patients resynchronization of the interventricular conduction system by biventricular stimulation leads to improvement of quality of life and NYHA (New York Heart Association) class [2,3]. In open heart operations the acute hemodynamic benefit of biventricular pacing can be used by implantation of temporary epicardial electrodes facilitating weaning from extracorporeal circulation in high risk patients with impaired left ventricular function and improving cardiac output postoperatively [4-6].…”

Kardiyak resenkronizasyon tedavisinde sol ventrikül elektrodu implantasyon teknikleri

“…Hedef dal küçük veya büyük olsun içerisindeki stylet veya guidewire çıkarıldığı zaman kıvrıntılı şekil alarak dal duvarına birkaç noktadan dayanan elektrodlar tercih edilmelidir. Çok büyük damarlar için geliştirilmiş özel fiksasyon sistemli elektrodlar bulunmaktadır (Şekil 13) [1,3,4,11]. …”