Use of left ventricular pacing in heart failure: evaluation by gated blood pool imaging.
BACKGROUND
Left ventricular (LV) pacing has been suggested to complement other forms of therapy in patients with heart failure.


RESULTS
We investigated 17 patients (15 men, 2 women, aged 68 +/- 6 years, 10 ischemic and 7 primary dilated cardiomyopathy) with heart failure (13 were in New York Heart Association class IV and 4 in class III). One month after LV pacer implantation, 12 patients reported clinical improvement (mean class 3.7 before pacing vs 2.6 with LV pacing; P = .001). We report the results of 3 equilibrium-gated blood pool studies performed in each patient, 1 before pacing and 2 after pacer implantation (1 with pacing on, and 1 after turning off the pacer). LV pacing did not modify LV ejection fraction. Phase analysis demonstrated a significant decrease of the interventricular phase shift (delta(pi)) with LV pacing (no pacing, delta(pi) = 8.99 degrees +/- 19.05 degrees; delta7n= -0.97 degrees +/- 27.85 degrees with LV pacing). Clinical improvement was observed in patients with an initial positive delta(pi) that decreased with pacing and/or an initial LV phase standard deviation >50 degrees that decreased with pacing.


CONCLUSIONS
LV pacing induces interventricular and intraventricular synchronization. A decrease of the interventricular phase shift seems to be the most important predictor of functional recovery for paced patients with heart failure.
Le Rest
C
C
Department of Nuclear Medicine, University Hospital Cavale Blanche, Brest, France.
Couturier
O
O
Turzo
A
A
Guillo
P
P
Bizais
Y
Y
Etienne
Y
Y
Blanc
J J
JJ
Narula
J
J
D000368:Aged; D002302:Cardiac Output / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000150:complications; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015637:Gated Blood-Pool Imaging; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000150:complications; D010138:Pacemaker, Artificial; D020127:Recovery of Function; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right / Q000502:physiology