BIVENTRICULAR PACING IN PATIENTS WITH SEVERE HEART FAILURE: SAFETY AND CLINICAL EFFICACY. 

G. Pettinati, D. Melissano, M. Sassara*, G. De Martino*

Divisione di Cardiologia- Ospedale “F.Ferrari” – Casarano

*Città di Lecce Hospital - Lecce

(VIII Southern Symposium on cardiac pacing - Giardini Naxos 9 - 12 october 2002) Reprints from: Mediterranean Journal of Pacing and Electrophysiology Volume 4, n.3, 2002)

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.