Cardiac resynchronization therapy: can we make our heart failure patients smarter?

Patients with congestive heart failure have impaired cognitive function, possibly caused by impaired global and regional cerebral blood flow. We hypothesized that biventricular pacing-simultaneous activation of the both the septum and the lateral wall of the left ventricle-would improve neurocognitive function and improve quality of life. Ten patients were examined before and after pacemaker implantation with standard measures of neurocognitive function. There were significant improvements in neurocognitive measures of attention (Digit Span: 50 +/- 5 vs. 57 +/- 7, p = 0.04) and information processing (Symbol Digit: 39 +/- 9 vs. 49 +/- 15, p = 0.04). There were also improvements in two psychosocial measure of quality of life: Left Ventricular Dysfunction-36 (13 +/- 7 vs. 7 +/- 5, p = 0.004) and Minnesota Living with Heart Failure Questionnaire (49 +/- 25 vs. 23 +/- 14, p = 0.02). These results translate into clinically significant functional benefits. We conclude that biventricular pacing improves cognitive and psychosocial outcomes, specifically in the domains of attention and speed of information processing.