Why the study?
Cardiac resynchronization therapy has been used for advanced heart failure with inter- and intraventricular dyssynchrony for more than ten years, motivating an assessment of midterm results of biventricular pacing.
Does biventricular pacing in cardiac resynchronization therapy improve functional status, left ventricular reverse remodeling, and midterm survival in patients with advanced heart failure and LBBB?
Cohort (n=128)
No
Does biventricular pacing in cardiac resynchronization therapy improve functional status, left ventricular reverse remodeling, and midterm survival in patients with advanced heart failure and LBBB?
This retrospective cohort study confirms that cardiac resynchronization therapy in routine clinical practice significantly improves NYHA class, LVEF, exercise capacity, and LV reverse remodeling at 3 months with a 77.9% two-year survival and acceptable complication rates.
OBJECTIVE: Cardiac resynchronization therapy has been used in the treatment of advanced heart failure with inter- and intraventricular dyssynchrony for more than ten years. AIM OF THE STUDY: A retrospective study was conducted to assess midterm results of biventricular (BiV) pacing in cardiac resynchronization therapy. METHODS: 128 consecutive patients (age 61.0+/-9.6, 98 males), with heart failure NYHA class 2.9+/-0.4 (2.5-3.5), with LBBB, QRS> or =130 ms, with dilated cardiomyopathy--DCM (86), with coronary artery disease--CAD (36), with both these etiologies (4) and with valvular disease (2) had a BiV PM (82) or BiV ICD (46) implanted in 2000-2007. AV delay was optimized individually, using echocardiography. Before and 3 months after implantation, the following was established: NYHA class, LVEF (echocardiographically), maximum oxygen uptake (spiroergometrically), left ventricle diastolic diameter and mitral regurgitation. The average follow-up time was 25.8+/-20.8 months. Complications and 2-year survival (n=68) were also assessed. RESULTS: 1) After 3 months of BiV pacing, NYHA class improved from 2.9+/-0.4 to 2.4+/-0.6 (n=99, p<0.001), LVEF increased from 20.2+/-4.9 to 23.9+/-6.6 % (n=92, p<0.001). Left ventricle diastolic diameter decreased from 69.8+/-8 to 67.5+/-10.0 mm (n=88, p=0.001) and mitral regurgitation was reduced from 2.2+/-0.9 to 1.9+/-0.9 (n=87, p=0.001) and maximum oxygen uptake during spiroergometry increased from 14.5+/-2.7 to 15.5+/-2.6 ml/min/kg (n=52, p=0.005). 2) Coronary sinus lead reposition was done in 2.3 %, epicardial lead implantation in 4.7 %, atrial lead reposition in 2.3 %, and right ventricular lead reposition in 2.3 % of patients. Contralateral reimplantation due to inflammatory complications in 1.6 % of patients. 3) Heart transplantation was performed on 9 patients. 4) Two-year survival was recorded in 77.9 % of 68 followed patients (72.2 % in CAD, 79.6 % in DCM). CONCLUSION: In the retrospective study of patients with BiV pacing a decline in heart failure, an increase in cardiac pump efficiency, reverse remodelling of left ventricle and acceptable occurrence of complications were confirmed (Tab. 4, Fig. 7, Ref. 18). Full Text (Free, PDF) www.bmj.sk
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Novák et al. (2007) conducted a cohort in Advanced chronic heart failure with left bundle branch block (QRS >=130 ms) (n=128). Cardiac resynchronization therapy (biventricular pacemaker or biventricular implantable cardioverter-defibrillator) vs. Baseline pre-implantation status (pre- vs. post-implantation comparison) was evaluated on LVEF and NYHA functional class at 3 months after biventricular pacing (p=<0.001).
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