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Published on: December 11, 2017
Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay
S Cazeau1, C Leclercq, T Lavergne
1InParys, Saint-Cloud, France.
Insights
Atriobiventricular pacing significantly improves exercise capacity and quality of life in heart failure patients with conduction delays. This therapy reduces hospitalizations and is preferred by most patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Chronic heart failure affects millions, with a significant portion experiencing intraventricular conduction delays.
- These delays can exacerbate left ventricular dysfunction due to asynchronous contractions.
- Previous studies suggest multisite biventricular pacing may improve cardiac function.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of atriobiventricular pacing in patients with chronic heart failure.
- To assess the impact of this therapy on exercise tolerance, quality of life, and hospitalizations.
Main Methods:
- A randomized, controlled crossover study involving 48 patients with severe heart failure and QRS duration >150 msec.
- Patients underwent three months of inactive pacing followed by three months of active atriobiventricular pacing.
- Primary endpoint was six-minute walk distance; secondary endpoints included quality of life, peak oxygen consumption, and hospitalizations.
Main Results:
- Active pacing led to a 22% increase in six-minute walk distance (p<0.001).
- Quality of life scores improved by 32% (p<0.001), and peak oxygen uptake increased by 8% (p<0.03).
- Hospitalizations decreased by two-thirds (p<0.05), with 85% of patients preferring active pacing (p<0.001).
Conclusions:
- Atriobiventricular pacing is a technically complex but effective therapy for heart failure patients.
- The therapy significantly enhances exercise tolerance and quality of life.
- This intervention reduces adverse events like hospitalizations in this patient population.
Background:
One third of patients with chronic heart failure have electrocardiographic evidence of a major intraventricular conduction delay, which may worsen left ventricular systolic dysfunction through asynchronous ventricular contraction. Uncontrolled studies suggest that multisite biventricular pacing improves hemodynamics and well-being by reducing ventricular asynchrony. We assessed the clinical efficacy and safety of this new therapy.
Methods:
Sixty-seven patients with severe heart failure (New York Heart Association class III) due to chronic left ventricular systolic dysfunction, with normal sinus rhythm and a duration of the QRS interval of more than 150 msec, received transvenous atriobiventricular pacemakers (with leads in one atrium and each ventricle). This single-blind, randomized, controlled crossover study compared the responses of the patients during two periods: a three-month period of inactive pacing (ventricular inhibited pacing at a basic rate of 40 bpm) and a three-month period of active (atriobiventricular) pacing. The primary end point was the distance walked in six minutes; the secondary end points were the quality of life as measured by questionnaire, peak oxygen consumption, hospitalizations related to heart failure, the patients' treatment preference (active vs. inactive pacing), and the mortality rate.
Results:
Nine patients were withdrawn from the study before randomization, and 10 failed to complete both study periods. Thus, 48 patients completed both phases of the study. The mean distance walked in six minutes was 22 percent greater with active pacing (399+/-100 m vs. 326+/-134 m, P<0.001), the quality-of-life score improved by 32 percent (P<0.001), peak oxygen uptake increased by 8 percent (P<0.03), hospitalizations were decreased by two thirds (P<0.05), and active pacing was preferred by 85 percent of the patients (P<0.001).
Conclusions:
Although it is technically complex, atriobiventricular pacing significantly improves exercise tolerance and quality of life in patients with chronic heart failure and intraventricular conduction delay.
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