November 1, 2000

Reversal of Left Ventricular Remodeling by Synchronous Biventricular Pacing in Heart Failure

Key Result

Synchronous biventricular pacing reversed left ventricular remodeling in heart failure, reducing end-diastolic (245 to 185 mL) and end-systolic volumes (209 to 140 mL) at 3 months (P<0.05).

Structured PICO

Does synchronous biventricular pacing reverse left ventricular remodeling and improve symptoms in patients with advanced heart failure and electromechanical conduction delay?

Population

n=11 patients with advanced heart failure (New York Heart Association Class III to IV), left ventricular ejection fraction < 35%, and QRS duration >= 140 ms

Intervention

Synchronous biventricular pacing via a biventricular dual chamber pacemaker for up to 3 months

Comparator

Baseline (before pacing)

Outcome

Left ventricular remodeling parameters (fractional shortening, ejection fraction, cardiac output, left ventricular end-diastolic volume, end-systolic volume, mitral regurgitation, and diastolic filling time) assessed by serial echocardiography at up to 3 monthssurrogate

Synchronous biventricular pacing for 3 months in patients with advanced heart failure and conduction delay is associated with significant reversal of left ventricular remodeling, improved systolic function, and decreased symptoms.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Synchronous biventricular pacing is a new nonpharmacological supplemental treatment of advanced heart failure associated with electromechanical conduction delay. However, the role of pacing on left ventricular remodeling is unknown. Eleven patients with New York Heart Association Class III to IV heart failure, a left ventricular ejection fraction or = 140 ms received a biventricular dual chamber pacemaker. Serial echocardiography, 6-minute hall walk, and Minnesota Living with Heart Failure quality-of-life (QOL) questionnaire were performed before and after up to 3 months of pacing. At 3 months there was a significant increase in fractional shortening (P < 0.001), ejection fraction (P < 0.001), and cardiac output (P < 0.05). The left ventricular end-diastolic volume (245 +/- 70 vs 185 +/- 37 mL, P < 0.05), end-systolic volume (209 +/- 69 vs 140 +/- 44 mL P < 0.05), and mitral regurgitation were reduced (P < 0.05), and diastolic filling time was lengthened (P < 0.05). There were also improvements in heart failure symptoms, an increase in 6-minute walk distance, and a decrease in QOL scores. Synchronous biventricular pacing for 3 months was associated with hemodynamic improvements, reversal of left ventricular remodeling, and increase in left ventricular systolic function, and a decrease in secondary mitral regurgitation.

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