Comparative effects of ventricular resynchronization therapy in heart failure patients with or without coronary artery disease.
In patients with advanced heart failure, intraventricular conduction delay (IVCD) and left ventricular systolic dysfunction (LVSD), multisite cardiac pacing can be proposed as an additive treatment. The aim of this study was to assess the clinical effectiveness of atrioventricular pacing according to the etiology of LVSD, by comparing the outcome of patients with and without coronary artery disease. Between August 1997 and November 1998, 103 patients were included in the InSync trial and received a biventricular pacemaker and a specifically designed left ventricular pacing lead. Baseline evaluation (12 lead ECG, New York Heart Association Class, quality of life (QOL) and distance walked during the 6 min walk test) was repeated in survival patients at 1, 3, 6 and 12 months after pacemaker implantation. Patients were split in two groups, ischemic (N = 48) and non-ischemic (N = 55), according the result of a recent coronary angiography, the existence of coronary angioplasty or coronary artery bypass or the history of a prior myocardial infarction.


RESULTS
The mortality rate was similar in the two groups with a mean 12 months actuarial survival rate of 78%. Nevertheless, the delay between the death and the pacemaker implantation was significantly higher in the non-ischemic group. A significant reduction in QRS duration and a significant improvement in NYHA class (-1.5). QOL score (-50%) and 6 min walking test (+18%) were observed similarly in the two groups.


CONCLUSIONS
This study shows that biventricular pacing improves significantly functional status of patients with LVSD, IVCD and advanced heart failure, regardless the etiology of the cardiomyopathy, ischemic or not, without over-mortality in ischemic patients.
Leclercq
C
C
Département de cardiologie et maladies vasculaires, Centre cardio-pneumologique, Hôpital Pontchaillou-CHU, rue Henri le Guilloux, 35033 Rennes cedex 9, France. christophe.leclercq@chu-rennes.fr
Gras
D
D
Tang
A
A
Alonso
C
C
Thomas-Revault d'Allones
F
F
Mabo
P
P
D000368:Aged; D002304:Cardiac Pacing, Artificial; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D008297:Male