Key result
Permanent LV-based pacing is associated with a ~3% LVEF increase and reduced MR.
Why the study?
Does permanent LV-based pacing improve LV function and reduce mitral regurgitation in patients with refractory congestive heart failure and left bundle branch block?
Observational (n=23)
Does permanent LV-based pacing improve LV function and reduce mitral regurgitation in patients with refractory congestive heart failure and left bundle branch block?
Absolute Event Rate: 26.2% vs 23.3%
p-value: p=<0.01
Permanent LV-based pacing significantly improves LV systolic function and decreases mitral regurgitation in patients with severe heart failure and left bundle branch block.
Should not yet change practice in refractory HF with LBBB; extends observational data but requires randomized confirmation.
BACKGROUND: Beneficial effects of left ventricular (LV)-based pacing on acute hemodynamic parameters were reported in several series, but only a few studies examined the long-term effects of this new pacing procedure. AIMS: To assess long-term effects of permanent LV-based pacing on LV function and mitral regurgitation (MR) in patients with refractory congestive heart failure (CHF). METHODS: A prospective evaluation of LV function and MR was performed in 23 patients with severe but stable CHF and left bundle branch block (mean QRS: 186+/-31 ms) by radionuclide and echocardiographic techniques at baseline and 6 months after implantation of a permanent LV-based (LV alone: 13 patients; biventricular: 10 patients) pacemaker programmed either in a DDD mode (sinus rhythm; n=14) or in a VVIR mode (atrial fibrillation; n=9). RESULTS: Compared to baseline, the 6 months follow-up visit demonstrated a significant increase in radionuclide derived LV ejection fraction from 23.3+/-7 to 26.2+/-7% (P<0.01) and in echocardiographic LV fractional shortening from 13+/-4 to 16+/-6% (P<0.05), without any change in cardiac index, a significant decrease in LV end-diastolic diameter (from 73.2+/-6 to 71.2+/-7 mm; P<0.05), end-systolic diameter (from 63.6+/-6 to 60.2+/-8 mm; P<0.05) and color Doppler MR jet area (from 11.5+/-6 to 6.6+/-4 cm(1); P<0.001). A comparison of patients with LV pacing alone and patients with biventricular pacing showed similar beneficial effects of pacing on MR severity in the two subgroups and a non-significant trend for a better improvement of LV function during biventricular pacing. CONCLUSION: Thus, in patients with severe CHF and left bundle branch block, permanent LV-based pacing may significantly improve LV systolic function and decrease MR.
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Yves et al. (2001) conducted an observational in refractory congestive heart failure (CHF) (n=23). Permanent LV-based pacing vs. Baseline was evaluated on Left ventricular ejection fraction (p=<0.01). Permanent LV-based pacing significantly increased LV ejection fraction from 23.3% to 26.2% (P<0.01) and decreased mitral regurgitation jet area (P<0.001) at 6 months.
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