Biventricular pacing combined to lCD in severe heart failure. One year follow-up evaluation

G. Pettinati, D. Melissano, F. De Santis, G. Storti

Division of Cardiology, “F Ferrari” Hospital, Casarano (Italy)

IXth Southern Symposium on Cardiac Pacing. (Giardini Naxos 29 september - 2 october 2005) Reprints from: Mediterranean Journal of Pacing and Electrophisyology. Volume 6, n.2, 2004

Biventricular Pacing (BP) is a treatment strategy in patients with severe heart failure, particularly when thye pathology seems to be resistant to the best conventional medical therapy available. The role of LCD combined to biventricular pacing in order to reduce the number of deaths diagnosed as sudden cardiac death, a fairly frequent out­come in patients with refractory heart failure, is still disputable.

The aim of this study was to verify the clinical response of patients undergoing a biventricular pacing therapy based omn a long term follow-up period of evaluation, moreover to verify wheter a BP therapy combining the use of an ICD could be considered an appropriate treatment strategy even in those cases which did not show an absolute evidence of prophylactic indication to ICD implantation.

Results: VT was identified in 192/3058 recorded eps of slow tachycardia in 51 pts. Among these eps, 153 (80%) in 49 pts terminated spontaneously (sp.) or decelerated below 101 bpm (duration: 7,6 ± 22,5 min), 12 (6%) accelerated above 148 bpm and were subsequently treated, 27 (14 %) were detected and treated after slow VT therapies activated by the physician. This activation was required because of re-hospitalisation for heart failure (n=3 pts), or occurrence of pal­pitations or dizziness (n=7 pts). Pts with slow & fast VT (31) presented a greater number of slow VT as compared to pts with slow VT only (18) (Wilcoxon test).

Conclusions: More than 25% of the study population presented with unexpected slow VTs. Activation of slow VT therapies was required in 5% of the slow VT pts population during FU.