Effectiveness of resynchronization therapy in patients with end-stage heart failure.
Biventricular pacing has been introduced to treat patients with end-stage heart failure, and short-term results of this technique are promising. Because data on longer follow-up are limited to 3-month follow-up, the sustained effect of biventricular pacing is unclear and long-term survival is unknown. Forty patients with end-stage heart failure in New York Heart Association (NYHA) functional class III or IV with left ventricular (LV) ejection fraction (EF) <35%, QRS duration >120 ms, and left bundle branch block morphology received a biventricular pacemaker. At baseline, and at 3 and 6 months after implantation, the following parameters were evaluated: NYHA class, Minnesota quality-of-life score, QRS duration on surface electrocardiogram, 6-minute walking distance, and LVEF. Long-term follow-up was obtained for up to 2 years. All clinical parameters improved significantly at 3 months and remained unchanged at 6-month follow-up. LVEF increased from 24 +/- 9% to 34 +/- 11%. Before implantation, patients were hospitalized (for congestive heart failure) an average of 3.9 +/- 5.3 days/year compared with 0.5 +/- 1.5 days/year after implantation. Long-term follow-up showed a survival of 87.5% at 2 years. Thus, biventricular pacing resulted in improvement of symptoms and quality of life, accompanied by improvement in 6-minute walking distance and LVEF. These effects were observed at 3 months after implantation and were maintained at 6-month follow-up. Moreover, 2-year survival was excellent.
Molhoek
Sander G
SG
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Bax
Jeroen J
JJ
van Erven
Lieselot
L
Bootsma
Marianne
M
Boersma
Eric
E
Steendijk
Paul
P
van der Wall
Ernst E
EE
Schalij
Martin J
MJ
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016277:Ventricular Function, Left