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Potential benefit of biventricular pacing in patients with congestive heart failure and ventricular tachyarrhythmia
C Stellbrink1, A Auricchio, B Diem
1Department of Cardiology and Internal Medicine, University of Technology, Aachen, Germany.
Insights
Biventricular pacing may improve outcomes for congestive heart failure (CHF) patients, especially those with advanced disease. This therapy, combined with defibrillation, could benefit a significant portion of CHF patients at risk for ventricular arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Congestive heart failure (CHF) treatment focuses on symptom relief and mortality reduction.
- Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death but lack proven mortality benefits in advanced CHF.
- Biventricular pacing shows potential for functional improvement in select CHF patients.
Purpose of the Study:
- To evaluate the potential benefit of biventricular pacing in patients with congestive heart failure (CHF).
- To identify the proportion of CHF patients meeting eligibility criteria for biventricular pacing based on NYHA class and QRS duration.
Main Methods:
- Retrospective analysis of 384 CHF patients' data.
- Assessment of New York Heart Association (NYHA) CHF class, QRS duration, PR interval, and atrial fibrillation incidence.
- Application of biventricular pacing eligibility criteria to patient data.
Main Results:
- Advanced CHF patients (NYHA class III) were older with longer mean QRS duration and PR intervals.
- Higher incidence of atrial fibrillation observed in NYHA class III patients.
- 7.3% of patients met criteria for biventricular pacing (NYHA class III), and 12.5% (NYHA class II with ejection fraction ≤30%).
Conclusions:
- Biventricular pacing, combined with defibrillation, is a potential therapeutic strategy for advanced CHF.
- A significant proportion of CHF patients may benefit from biventricular pacing, particularly those at risk for ventricular tachyarrhythmia.
Abstract:
Treatment of congestive heart failure (CHF) aims for symptomatic relief and reduction of mortality both from sudden death and pump failure. The implantable cardioverter defibrillator (ICD) is highly effective in the prevention of sudden death, but no mortality benefit in advanced CHF has yet been shown. Biventricular pacing may lead to functional improvement in selected patients with CHF. Thus, a biventricular pacemaker with defibrillation capabilities may be ideal for patients with advanced CHF. We retrospectively analyzed the data from 384 patients (age 59 +/- 12 years, 322 male and 62 female) with regard to New York Heart Association (NYHA) CHF class, mean QRS duration, mean PR interval, presence of a QRS > 120 msec and incidence of atrial fibrillation at the time of ICD implantation. Based on eligibility criteria from studies in biventricular pacing, we analyzed how many patients may benefit from biventricular pacing. Patients with CHF were older (NYHA class III: 60.9 +/- 9.7, class II: 61.3 +/- 10 versus class I: 50.8 +/- 13.6 years, p < 0.001 each) and mean QRS duration was longer with advanced CHF (NYHA class III 127.8 +/- 30 msec; class II 119.4 +/- 27.7 msec; class 0-1: 103.9 +/- 17.7 msec, p < 0.001, analysis of variance) as was the mean PR interval (NYHA class III 189.9 +/- 33.5 msec; class II 176.1 +/- 29.3 msec; class 0-1 162.7 +/- 45.9 msec, p < 0.001, analysis of variance). The incidence of atrial fibrillation was higher in class III (25.5%) compared with class 0-1 (16.9%) and class II patients (14.1%, p = 0.043, chi-square test). A total of 28 patients (7.3%) fulfilled eligibility criteria for biventricular pacing if NYHA class III patients were considered candidates and 48 (12.5%) if patients with NYHA II CHF and ejection fraction < or = 30% were included. Thus, biventricular pacing may offer a promising therapeutic approach for a significant proportion of patients with CHF at risk for ventricular tachyarrhythmia.