title: Bifocal pacing in the right ventricle: an alternative to resynchronization when left ventricular access is not possible in end-stage heart failure patients.
abstract: BACKGROUND
  It has been reported that bifocal pacing (BiF) in the right ventricle might be an alternative to unsuccessful left ventricular lead implantation. This case report presents an assessment of the clinical and hemodynamic parameters during a three month follow-up in patients implanted with right ventricular BiF.
  
  
  METHODS
  Eight patients who underwent unsuccessful left ventricular lead implantation were implanted with a bifocal system in the right ventricular. Leads were implanted in the right atrium appendage, the apex and the right ventricular outflow tract and connected to the cardiac resynchronization therapy pacemaker. All patients performed a sixminute walking test and underwent echocardiography after the implantation and after the three month follow-up.
  
  
  RESULTS
  We found a significant performance increase in the six minute walking test and reduction in New York Heart Association class and mitral regurgitation in echocardiography study, as well as a significant increase in left ventricular ejection fraction, and cardiac output directly after the implantation, as well as at threemonth follow-up in patients after BiF implantation.
  
  
  CONCLUSIONS
  Right ventricular bifocal pacing in patients with cardiac resynchronization therapy indication and unsuccessful left ventricular lead placement seems to be a beneficial treatment for heart failure. Satisfactory hemodynamic and clinical results were observed directly after BiF implantation and during the three month follow-up.
authors.affiliation: Department of Electrocardiology, Medical University of Łódź, Poland. michalchudzik@wp.pl
authors.forename: Michał
authors.initials: M
authors.lastname: Chudzik
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Piestrzeniewicz
authors.forename: Artur
authors.initials: A
authors.lastname: Klimczak
authors.forename: Joanna
authors.initials: J
authors.lastname: Gawłowska
authors.forename: Andrzej
authors.initials: A
authors.lastname: Oszczygieł
authors.forename: Jerzy Krzysztof
authors.initials: JK
authors.lastname: Wranicz
authors.forename: Karol
authors.initials: K
authors.lastname: Bartczak
mesh_terms: D000368:Aged; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods; D012086:Reoperation; D013318:Stroke Volume; D017211:Treatment Failure; D016896:Treatment Outcome; D016138:Walking