Biventricular Pacing May Have Edge in Severe Heart Failure
Biventricular pacing appears to achieve better results than does left ventricular pacing in certain patients with heart failure and chronic atrial fibrillation, French researchers report in the June issue of Heart.
Dr. Stephane Garrigue of Hôpital Cardiologique du Haut-Leveque, Pessac, and colleagues conducted a single-blind randomized crossover study of 13 such patients who had QRS prolongation of 140 ms or more.
They underwent His bundle ablation and installation of a pacemaker capable of left ventricular and biventricular pacing. Furthermore, the device was equipped with an accelerometer, and Dr. Garrigue told Reuters Health that “by simply interrogating the pacemaker, an accurate, automatic and noninvasive assessment of cardiac function can be performed over a 2-month followup.”
After a baseline period of right ventricular pacing, patients were randomized to 2 months of left ventricular pacing and 2 months of biventricular pacing.
Peak endocardial acceleration (PEA) was higher with both left ventricular and biventricular pacing than at baseline. Results of a 6-minute walking test showed that although performance was similar in both groups, those with left ventricular pacing had more symptoms at the end of the test (p=0.035).
Furthermore, cardiopulmonary exercise tests showed that biventricular pacing provided greater improvement (p=0.03) and a greater increase in mean percentage variation of PEA (p=0.048).
Both modalities provided similar improvements at rest, but the researchers conclude that during daily activities and symptom-limited exercise “biventricular pacing allowed better performance than left ventricular pacing along with improved hemodynamic measurements and significantly fewer ventricular arrhythmias.”
Dr. Garrigue added that the sensor-equipped pacemaker “is very promising in assessing the hemodynamically optimal pacing mode for each patient, especially if she or he presents with severe heart failure.” Such information could make “the physician reconsider the medical treatment” of a given patient.
Heart 2002;87:529-534.
