Biventricular
stimulation can improve systolic function in patients with heart failure
and conduction disorders, because
left ventricular pacing removes dissynchrony of contraction and
mytralic regurgitation.
Aim
of the study is to assess feasibility, clinical efficacy, complication
and follow up of biventricular stimulation in patients affected by
severe heart failure.
MATERIAL
AND METHODS
We
have studied 36
patients, 28 males and 8 females, age 56 – 75 years,
III IV class NYHA, affected by ischemyc myocardiopathy (15),
dilated myocardiopathy (13)
and others (8), E.F. <35% QRS >120ms, PQ >200 ms. 3
patients presented also atrial fibrillation. We implanted in 25 cases Pm
Contak TR Guidant, in 11 cases Renewal Guidant ICD due to the presence
of sustained
T.V.,the leads was placed in postero-lateral vein (28) and posterior
vein (8). We treated 2 cases with left ventricular epicardic lead. In
the of atrial fibrillation cases,the left ventricular lead was connected
at the right atrial channel and programmed in DDD with an A.V. delay of
0,10 ms. The mean time of implantation was 100 (+/- 20 m’).,
and video scope 15( +/- 6 m’).
RESULTS
During
the follow up of 8( +/- 5) months we observed 3 death (8%), 1 sudden
death and 2 progressive pump failure. We verified clinical improvement
in 24/33 patients (69%). E.F. increased from 30,2% (+/- 5) on the
pre-implant period to 36,1% (+/- 2) after biventricular pacing, the NYHA
class decreased from 3, 2 (+/- 1) to 2,0 (+/- 0,7) and the total
rehospitalization rate from 20 to 5.Among the 11 ICDs paced patients, 2
presented appropriate interventions by ATP function and interruption of
ventricular tachicardia. We observed not procedure-linked complications,
not lead dislogement.
CONCLUSION
In
our experience, the biventricular pacing in patients with severe heart
failure is safe and improves
systolic function and clinical efficacy in 69% of cases.
