Ventricular endocardial right bifocal stimulation in treatment of severe dilated cardiomyopathy heart failure in patients with unsuccessful biventricular pacemaker implantation

In a minority patients (pts) the endocardial approach to the left ventricular fails due to advanced heart disease or anatomic factors. In such pts bifocal endocardial pacing in right ventricle might be the profitable alternative. The aim of the study was to assess the clinical and hemodymanic parameters in pts with with bifocal pacing and severe heart failure. 9 pts (6 males, 3 female) with mean age 68±8 years, in heart failure (at NYHA functional class IV), with QRS duration > 130 ms, with LVEF < 35% were included to the study. In all pts endocardial left ventricular approach was failed. Then, bifocal pacing system (one lead to the apex of the right ventricle (RVA) and the other to the right ventricle outflow tract (RVOT) was implanted. Atrial lead was inserted to the right atrial appendage. Next, all leads were connected to the three chamber pacemaker (Biotronik Stratos LV). Echo study in every pts with A-Vdelay and V-V delay optimisation was performed. Following parameters before (Bimpl) and after procedure (Aimpl) (from 2 to 8 , mean 5,6±3 days) were estimated: NYHA functional class (NYHA), 6 minute walking test (6MWT), left ventricular ejection fraction (LVEF), left ventricular diastolic diameter (LVdD), left ventricular systolic diameter (LVsD), cardiac output (CI) and cardiac index (CI). The results are presented in table below: During the short term follow up in selected pts in whom achievment of pacingthrough a venous branch of coronary sinus was not possible and bifocal system in right ventricle was implanted, significant improvment in NYHA functional class, 6 minute walking test and in the majority of hemodynamic parametrers was reported.