BACKGROUND:Biventricular (BiV) stimulation lowers morbidity and mortality in patients with drug-refractory congestive heart failure (CHF), depressed left ventricular (LV) function, and ventricular dyssynchrony in absence of indication for permanent cardiac pacing. This pilot, single-blind, randomized, cross-over study examined the safety and efficacy of upgrading conventional pacing systems to BiV stimulation in patients with advanced CHF. METHODS: We included 56 patients in New York Heart Association (NYHA) functional classes III or IV despite optimal drug treatment and ventricular dyssynchrony (interventriclar delay > 40 ms or LV preejection delay > 140 ms) in need of pacemaker replacement. We compared the patients' functional status, arrhythmias, and standard echocardiographic measurements during 3 months of conventional, single right ventricular (RV) versus 3 months of BiV stimulation. RESULTS: There were 44 patients in the cross-over phase. QRS duration was shortened by 23% and LV preejection delay by 16% with BiV stimulation. NYHA functional class, 6-minute hall walk and quality of life score were significantly improved with BiV stimulation compared with single RV pacing by 18%, 29%, and 19%, respectively. No significant difference was observed in the ventricular arrhythmia burden or LV reverse remodeling between the 2 periods. CONCLUSIONS: This pilot study showed that upgrading from RV pacing to BiV pacing significantly improves symptoms and exercise tolerance in chronically paced patients with advanced CHF and mechanical dyssynchrony.
RCT Entities:
BACKGROUND: Biventricular (BiV) stimulation lowers morbidity and mortality in patients with drug-refractory congestive heart failure (CHF), depressed left ventricular (LV) function, and ventricular dyssynchrony in absence of indication for permanent cardiac pacing. This pilot, single-blind, randomized, cross-over study examined the safety and efficacy of upgrading conventional pacing systems to BiV stimulation in patients with advanced CHF. METHODS: We included 56 patients in New York Heart Association (NYHA) functional classes III or IV despite optimal drug treatment and ventricular dyssynchrony (interventriclar delay > 40 ms or LV preejection delay > 140 ms) in need of pacemaker replacement. We compared the patients' functional status, arrhythmias, and standard echocardiographic measurements during 3 months of conventional, single right ventricular (RV) versus 3 months of BiV stimulation. RESULTS: There were 44 patients in the cross-over phase. QRS duration was shortened by 23% and LV preejection delay by 16% with BiV stimulation. NYHA functional class, 6-minute hall walk and quality of life score were significantly improved with BiV stimulation compared with single RV pacing by 18%, 29%, and 19%, respectively. No significant difference was observed in the ventricular arrhythmia burden or LV reverse remodeling between the 2 periods. CONCLUSIONS: This pilot study showed that upgrading from RV pacing to BiV pacing significantly improves symptoms and exercise tolerance in chronically paced patients with advanced CHF and mechanical dyssynchrony.
Authors: Ian P Clements; Stuart Christenson; David O Hodge; Brian P Mullan; Margaret M Redfield; David L Hayes Journal: J Nucl Cardiol Date: 2010-12-03 Impact factor: 5.952
Authors: Jonathan G Howlett; Robert S McKelvie; J Malcolm O Arnold; Jeannine Costigan; Paul Dorian; Anique Ducharme; Estrellita Estrella-Holder; Justin A Ezekowitz; Nadia Giannetti; Haissam Haddad; George A Heckman; Anthony M Herd; Debra Isaac; Philip Jong; Simon Kouz; Peter Liu; Elizabeth Mann; Gordon W Moe; Ross T Tsuyuki; Heather J Ross; Michel White Journal: Can J Cardiol Date: 2009-02 Impact factor: 5.223