title: Ventricular endocardial right bifocal stimulation in the treatment of severe dilated cardiomyopathy heart failure with wide QRS.
abstract: The QRS widening by ventricular conventional pacing impairs the systolic and diastolic functions and increases mitral regurgitation. The aim of this study was to compare conventional pacing to an alternative stimulation mode with a narrower QRS using two leads in the RV. Thirty-nine (25 men, 14 women; mean age 60.1 +/- 15.1 years) dilated cardiomyopathy patients (Chagas' disease [n = 17], coronariopathy [n = 9], AV ablation for tachycardiomyopathy [n = 3], and other [n = 10]) with cardiac failure (NYHA 3.1 +/- 0.8), pacemaker indication, and chronic AV block (22 AF) had endocardial pacemaker implantations (27 Biotronik, 12 Guidant). Two RV leads (one septal, one conventional [RV apex] were connected, respectively, to the atrial and ventricular pacemaker plugs. After clinical stabilization they were studied under three stimulation modes in the same session: AAI (septal), VVI (conventional), and ventricular endocardial right bifocal stimulation (VERBS) (DDT/DVI/DDD = AV interval = 15/10 ms). In comparison to conventional pacing, VERBS increased ejection fraction (0.124), cardiac output (19.5%), and peak filling rate (31.0%), and decreased QRS duration (24.7%), left atrium area (11.9%), mitral regurgitation area (32.3%), the diastolic transmitral flow (E/A relation) (19.3%), and the propagation flow time (18.0%) from the mitral valve to the left ventricular apex (tE_col), (P < 0.05). The quality-of-life showed an impressive score reduction of 50.4%. The septal stimulation alone showed a less expressive benefit. In severe dilated cardiomyopathy with classic pacemaker indication, VERBS showed significantly better performance than the septal or the conventional stimulation alone. There was a good systolic and a remarkable diastolic improvement causing an important reduction in the quality-of-life score.
authors.affiliation: Departments of Pacemaker, Cardiovascular Surgery, and Cardiomyopathy, São Paulo Dante Pazzanese Cardiology Institute, University of São Paulo, Brazil. jcpachon@hotmail.com
authors.forename: J C
authors.initials: JC
authors.lastname: Pachón
authors.forename: E I
authors.initials: EI
authors.lastname: Pachón
authors.forename: R N
authors.initials: RN
authors.lastname: Albornoz
authors.forename: J C
authors.initials: JC
authors.lastname: Pachón
authors.forename: D S
authors.initials: DS
authors.lastname: Kormann
authors.forename: V M
authors.initials: VM
authors.lastname: Gimenes
authors.forename: P T
authors.initials: PT
authors.lastname: Medeiros
authors.forename: M A
authors.initials: MA
authors.lastname: Silva
authors.forename: J E
authors.initials: JE
authors.lastname: Sousa
authors.forename: P P
authors.initials: PP
authors.lastname: Paulista
authors.forename: L C
authors.initials: LC
authors.lastname: Souza
authors.forename: A D
authors.initials: AD
authors.lastname: Jatene
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D004567:Electrodes, Implanted; D004699:Endocardium / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000628:therapy; D010138:Pacemaker, Artificial; D011788:Quality of Life; D013318:Stroke Volume / Q000502:physiology