[Biventricular pacemaker treatment of patients with severe heart failure].
BACKGROUND
Biventricular pacing using a pacemaker lead located epicardially on the left ventricle, introduced via the coronary sinus to a coronary vein, and one pacemaker lead located endocardially at the apex of the right ventricle can resynchronize the contraction of the left ventricle. Approximately 30-50% of patients with severe heart failure have left bundle branch block indicating asynchronous contraction of the left ventricle. These patients can have a significant haemodynamic benefit from biventricular pacing.


METHODS
The methods for implanting the leads are described. Biventricular pacemakers were implanted in five patients.


RESULTS
Acceptable low thresholds for pacing the left ventricle were achieved. Resynchronization of the contraction of the left ventricle was demonstrated by using colour tissue Doppler measurements. The mechanisms for the haemodynamic benefit of biventricular pacing are discussed on the basis of our data. The first patient has been followed for 12 months. He has a lasting improvement in functional capacity from class IV to class II, marked reduction of the left ventricular size, and improvement of the left ventricular ejection fraction from 15% to 38%.


CONCLUSIONS
The results are promising for patients who, because of lack of donor hearts and age criteria, often cannot be offered heart, transplantation.
Faerestrand
S
S
Hjerteavdelingen Haukeland Sykehus 5021 Bergen. svein.faerestrand@med.uib.no
Schuster
P
P
Ohm
O J
OJ
D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D010138:Pacemaker, Artificial; D018579:Patient Selection; D016896:Treatment Outcome