Midterm benefits of left univentricular pacing in patients with congestive heart failure.
BACKGROUND
Resynchronization therapy by simultaneous pacing of the right and left ventricles has gained wide acceptance as a useful treatment for patients with severe congestive heart failure. Several short-term hemodynamic studies in humans and animals failed to demonstrate any benefit of biventricular pacing over left univentricular pacing, but long-term studies on this pacing mode are lacking. The objective of this study was to assess the outcome over a 1-year period of patients paced exclusively in the left ventricle.


RESULTS
Clinical, angiographic, echocardiographic, and ergometric data were collected at baseline and after 12 months in 22 patients (age, 69.3+/-6.5 years) with NYHA class III or IV (10 patients), sinus rhythm, left bundle-branch block, and no bradycardia indication for pacing. After 12 months, compared with baseline values, NYHA class improved significantly by 40% (P<0.0001), 6-minute walk distance by 30% (P=0.01), peak VO2 by 26% (P=0.01), left ventricular end-diastolic diameter by 5% (P=0.02), ejection fraction by 22% (P=0.07), mitral regurgitation area by 40% (P=0.01), and norepinephrine level by 37% (P=0.04).


CONCLUSIONS
In patients with severe congestive heart failure, sinus rhythm, and left bundle-branch block despite optimal pharmacological treatment, left univentricular pacing is feasible and results in significant midterm benefit in exercise tolerance and left ventricular function.
Blanc
Jean-Jacques
JJ
Brest University Hospital, Brest, France. jean-jacques.blanc@univ-brest.fr
Bertault-Valls
Valérie
V
Fatemi
Marjaneh
M
Gilard
Martine
M
Pennec
Pierre-Yves
PY
Etienne
Yves
Y
D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D004232:Diuretics / Q000627:therapeutic use; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption; D011446:Prospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D016138:Walking
D002317:Cardiovascular Agents; D004232:Diuretics; D009638:Norepinephrine