Improvement of congestive heart failure by upgrading of conventional to resynchronization pacemakers.
OBJECTIVE
To compare the clinical response of patients with right ventricular apical pacing (RVAP) upgraded to cardiac resynchronization therapy (CRT) to that of previously nonpaced heart failure (HF) patients who had de novo CRT implantation.


BACKGROUND
The role of CRT in patients with wide QRS and HF due to RVAP is less well established than in other CRT candidates.


METHODS
Ninety-eight consecutive patients with CRT were studied (mean age 70, mean ejection fraction 0.23). Group A: patients having RVAP prior to CRT implantation (n = 25), group B: patients without prior RVAP (n = 73). Clinical and echocardiographic parameters were recorded prior to, and 3 months after, CRT implantation.


RESULTS
Group A patients had a wider QRS at baseline compared to group B (203 +/- 32 ms vs 163 +/- 30 ms respectively, P < 0.001), and a shorter 6-minute walking distance (222 +/- 118 m vs 362 +/- 119 m, respectively, P < 0.005). Otherwise, clinical and echocardiographic parameters were not different. At follow up, group A patients had an average 0.7 +/- 0.5 decrease in their NYHA functional class, compared to 0.3 +/- 0.7 in group B patients (P < 0.05). Six-minute walking distance increased by 93 +/- 113 m in group A, versus 36 +/- 120 m in group B (P = 0.22). There was no difference in echocardiographic response to CRT between the groups.


CONCLUSIONS
HF patients with prior RVAP demonstrate clinical improvement after upgrading to CRT that is comparable, and in some aspects, even better than that observed in HF patients with native conduction delay who undergo de novo CRT implantation.
Marai
Ibrahim
I
Heart Institute, Sheba Medical Center, Tel-Hashomer, and Sackler School of Medicine, Tel-Aviv University, Israel.
Gurevitz
Osnat
O
Carasso
Shemy
S
Nof
Eyal
E
Bar-Lev
David
D
Luria
David
D
Arbel
Yaron
Y
Freimark
Dov
D
Feinberg
Micha S
MS
Eldar
Michael
M
Glikson
Michael
M
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D016896:Treatment Outcome; D014463:Ultrasonography