Long-term follow-up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure.
BACKGROUND
Besides standard left ventricular (LV) stimulation via the coronary sinus, a transseptal approach allows left ventricular endocardial stimulation. We report our long-term observations with biventricular stimulation, using a strictly endocardial system for patients presenting with severe congestive heart failure.


METHODS
Six patients with nonischemic cardiomyopathy (mean age = 60 +/- 9.6 years, women) in New York Heart Association (NYHA) functional class III (n = 5) or IV, despite optimal drug therapy, and a mean LV ejection fraction of 24 +/- 3%, underwent implantation of biventricular stimulation systems between April 1998 and March 1999. All presented with left bundle branch block and an increased LV end-diastolic diameter (mean = 66 +/- 5 mm). In all patients, a bipolar pacing lead was implanted in the lateral LV wall using a direct transseptal approach. After implantation, all patients received oral anticoagulation.


RESULTS
QRS duration decreased from 184 +/- 22 ms to 108 +/- 11 ms. NYHA functional class decreased to II in all patients within 1 month. Over a 85 +/- 5 month follow-up, two patients underwent cardiac transplantation, 2 and 4 years after device implantation, respectively; two patients died of end-stage heart failure 4 years after system implantation; and two patients were alive in functional class II. One patient, who experienced syncope due to fast ventricular, underwent implantation of an ICD. One transient ischemic attack occurred in a patient whose anticoagulation was temporarily interrupted.


CONCLUSIONS
Long-term endocardial biventricular stimulation via a transseptal approach was safe and effective in this small population. This approach needs to be further compared with conventional epicardial pacing via the coronary sinus.
Pasquié
J L
JL
Clinique des Maladies du Coeur et des Vaisseaux, Hôpital Arnaud de Villeneuve, Centre Hospitalo-Universitaire de Montpellier, France. jl-pasquie@chu-montpellier.fr
Massin
F
F
Macia
J C
JC
Gervasoni
R
R
Bortone
A
A
Cayla
G
G
Grolleau
R
R
Leclercq
F
F
D000368:Aged; D002037:Bundle-Branch Block; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006346:Heart Septum; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016896:Treatment Outcome