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Pacing Techniques Results Similar For Congestive Heart Failure
A DGReview of :"Long-term left ventricular pacing: assessment and comparison with biventricular pacing in patients with severe congestive heart failure"
Journal of the American College of Cardiology (JACC)
12/13/2001
By Harvey McConnell
Both left ventricular based and left bundle branch block pacing in patients with severe congestive heart failure produce almost equivalent improvement of subjective and objective parameters.
This has been found in a comparative study by Dr Abdelkader Touiza and colleagues at the Department of Cardiology, Brest University Hospital, Brest, France, at six-month follow-up of permanent left ventricular (LV) based pacing in patients with severe congestive heart failure (CHF) and left bundle branch block (LBBB).
Clinicians point out: "Left ventricular pacing alone has been demonstrated to result in identical improvement compared to biventricular pacing (BiV) during acute hemodynamic evaluation in patients with advanced CHF and LBBB. However, to our knowledge, the clinical outcome during permanent LV pacing alone versus BiV pacing mode has not been evaluated."
Among 33 patients in the study LV or BiV was selected according to the physician's preference, with evaluation carried out at baseline and at six months.
Baseline characteristics of the 18 LV and 15 BiV patient pacing groups were similar. During the six-month follow-up period, seven patients died-- three BiV and four LV.
Dr Touiza and colleagues found that in the surviving patients at six months, eight of 14 patients in the LV group, and nine of 12 in the BiV group, could be placed in New York Heart Association class I or II. No significant difference was observed between the two groups in terms of objective parameters except for LV end-diastolic diameter decrease (-4.4 mm in BiV group vs. -0.7 mm in LV group).
At six-month follow-up, a trend toward improvement was observed in objective parameters in patients with severe CHF and LBBB following LV-based pacing. The two pacing modes (LV and BiV) were associated with almost equivalent improvement of subjective and objective parameters.
Dr Touiza and colleagues concluded: "At six-month follow-up, a trend toward improvement was observed in objective parameters in patients with severe CHF and LBBB following LV-based pacing. The two pacing modes (LV and BiV) were associated with almost equivalent improvement of subjective and objective parameters."
JACC Vol 38, Iss 7, pp 1966-1970.
"Long-term left ventricular pacing: assessment and comparison with biventricular pacing in patients with severe congestive heart failure"
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