Mid-term follow-up of endocardial biventricular pacing.

Biventricular (BV) pacing is a promising treatment of end-stage heart failure. This article describes our experience with a strictly endocardial BV pacing system in patients with severe congestive heart failure. Three women and eight men (age 65 +/- 9 years) with drug-resistant end-stage CHF underwent implantation of an endocardial BV pacing system. In the first seven patients, the left ventricular lead was placed via a combined femoral and internal jugular approach. In the last four patients, the transseptal puncture was directly performed via the right internal jugular vein with a dedicated kit. The procedure was successful in all 11 patients. The acute left ventricular and BV thresholds were 1.3 +/- 0.6 V and 2.4 +/- 1 V, respectively. The QRS duration decreased from 214 +/- 57 to 176 +/- 25 ms. A functional improvement was noted in ten patients with a decrease in mean NYHA functional class from 3.7 +/- 0.5 before, to 2.6 +/- 0.9 after system implantation. A significant decrease in pulmonary capillary wedge pressure and increase in cardiac output were measured in eight patients. During follow-up, four patients died from CHF (n = 3) or ventricular fibrillation (n = 1). Under oral anticoagulation, no thromboembolic event was observed but one transient ischemic attack occurred in one patient whose anticoagulation was interrupted. Endocardial BV pacing is technically feasible and appears safe, though further studies are needed before it is used on a longer scale.