title: Transoesophageal left ventricular pacing in heart failure patients with permanent right ventricular pacing.
abstract: BACKGROUND
  Previous studies of biventricular (BV) pacing for treatment of heart failure (HF) patients with left bundle branch block (LBBB) evaluated responders to BV pacing with acute transvenous left ventricular (LV) pacing and arterial pulse pressure (PP). The aim of this study was to assess transoesophageal LV pacing in evaluation of the haemodynamic response with a view to upgrading responders from permanent right ventricular (RV) pacing to BV pacing.
  
  
  RESULTS
  Ten HF patients (age 62+/-8 years; one female, nine males) in NYHA III, LV ejection fraction 24+/-9% and permanent RV pacing by means of an implanted pacemaker or ICD were tested using transoesophageal LV pacing and PP. Permanently RV-paced HF patients were analysed with transoesophageal atrial sensed LV pacing in VAT mode with a different AV delay (n = 6) and with transoesophageal LV pacing in V00 mode during atrial fibrillation (n = 4). In five responders, PP was higher during transoesophageal LV pacing than PP during RV pacing (74+/-42 versus 57+/-31 mmHg, P = 0.015). Responders were upgraded by means of an LV lead via the coronary sinus in the posterior (n = 1) or posterolateral (n = 4) walls and after attaining a high LV pacing threshold with an epicardial LV lead on the anterior (n = 1) or anterolateral (n = 1) walls. NYHA class improved from 3 to 2+/-0.3 (P = 0.003) during 204+/-120 days follow-up and cardiac output increased from 4.4+/-1.5 to 5.6+/-1.7 l/min (P = 0.027) when comparing BV pacing and optimal AV delay with RV pacing. In five nonresponders, PP was not higher during transoesophageal LV pacing than during RV pacing.
  
  
  CONCLUSIONS
  Transoesophageal LV pacing may be a useful technique to detect responders to BV pacing in permanently RV-paced HF patients.
authors.affiliation: Department of Internal Medicine I, Cardiology Division, University of Jena, Erlanger Allee 101, D-07740 Jena, Germany. matthias.heinke@med.uni-jena.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Heinke
authors.forename: Ralf
authors.initials: R
authors.lastname: Surber
authors.forename: Helmut
authors.initials: H
authors.lastname: Kühnert
authors.forename: Gudrun
authors.initials: G
authors.lastname: Dannberg
authors.forename: Gero
authors.initials: G
authors.lastname: Schwarz
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D002037:Bundle-Branch Block / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial