Related Experiment Videos
Mid-term follow-up of endocardial biventricular pacing
P Jaïs1, A Takahashi, S Garrigue
1Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France.
Insights
Endocardial biventricular (BV) pacing offers a feasible treatment for severe heart failure, improving patient function and hemodynamics. While safe, further research is needed for long-term efficacy in heart failure management.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- End-stage heart failure significantly impacts patient quality of life and prognosis.
- Biventricular (BV) pacing is an established therapy for heart failure, but endocardial approaches are less common.
- Drug-resistant congestive heart failure (CHF) necessitates advanced treatment options.
Purpose of the Study:
- To evaluate the feasibility, safety, and efficacy of a strictly endocardial BV pacing system.
- To assess the impact of endocardial BV pacing on heart failure symptoms and hemodynamic parameters.
- To report procedural outcomes and patient follow-up for this novel pacing strategy.
Main Methods:
- Eleven patients with end-stage CHF underwent implantation of an endocardial BV pacing system.
- Left ventricular lead placement involved transvenous approaches, including transseptal puncture in later cases.
- Acute pacing parameters, QRS duration, functional class, and hemodynamic measures were assessed.
Main Results:
- The implantation procedure was successful in all 11 patients.
- Significant improvements were observed in QRS duration, NYHA functional class, pulmonary capillary wedge pressure, and cardiac output.
- Acute pacing thresholds were within acceptable ranges, and no thromboembolic events occurred under anticoagulation.
Conclusions:
- Strictly endocardial BV pacing is technically feasible and appears safe for selected patients with end-stage heart failure.
- The system demonstrated positive effects on cardiac function and patient symptomatology.
- Longer-term studies are warranted to establish the definitive role of endocardial BV pacing in heart failure management.
Abstract:
Biventricular (BV) pacing is a promising treatment of end-stage heart failure. This article describes our experience with a strictly endocardial BV pacing system in patients with severe congestive heart failure. Three women and eight men (age 65 +/- 9 years) with drug-resistant end-stage CHF underwent implantation of an endocardial BV pacing system. In the first seven patients, the left ventricular lead was placed via a combined femoral and internal jugular approach. In the last four patients, the transseptal puncture was directly performed via the right internal jugular vein with a dedicated kit. The procedure was successful in all 11 patients. The acute left ventricular and BV thresholds were 1.3 +/- 0.6 V and 2.4 +/- 1 V, respectively. The QRS duration decreased from 214 +/- 57 to 176 +/- 25 ms. A functional improvement was noted in ten patients with a decrease in mean NYHA functional class from 3.7 +/- 0.5 before, to 2.6 +/- 0.9 after system implantation. A significant decrease in pulmonary capillary wedge pressure and increase in cardiac output were measured in eight patients. During follow-up, four patients died from CHF (n = 3) or ventricular fibrillation (n = 1). Under oral anticoagulation, no thromboembolic event was observed but one transient ischemic attack occurred in one patient whose anticoagulation was interrupted. Endocardial BV pacing is technically feasible and appears safe, though further studies are needed before it is used on a longer scale.