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[Biventricular pacemaker treatment of patients with severe heart failure]
S Faerestrand1, P Schuster, O J Ohm
1Hjerteavdelingen Haukeland Sykehus 5021 Bergen. svein.faerestrand@med.uib.no
Insights
Biventricular pacing resynchronizes left ventricular contraction in heart failure patients with left bundle branch block. This therapy offers significant hemodynamic benefits and improved functional capacity, serving as a promising alternative to heart transplantation.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Severe heart failure affects 30-50% of patients with left bundle branch block, causing asynchronous left ventricular contraction.
- Biventricular pacing, utilizing epicardial and endocardial leads, can resynchronize left ventricular function.
- Patients with left bundle branch block may experience significant hemodynamic benefits from biventricular pacing.
Observation:
- The study describes lead implantation methods for biventricular pacemakers in five patients.
- Low pacing thresholds for the left ventricle were successfully achieved.
- Color tissue Doppler measurements confirmed left ventricular resynchronization.
Findings:
- Biventricular pacing led to a lasting improvement in functional capacity from NYHA class IV to II in one patient over 12 months.
- Significant reduction in left ventricular size and improvement in ejection fraction from 15% to 38% were observed.
- Mechanisms underlying the hemodynamic benefits of biventricular pacing were discussed based on the collected data.
Implications:
- Promising results suggest biventricular pacing as a viable treatment option for heart failure patients ineligible for heart transplantation due to donor heart scarcity or age restrictions.
- This approach offers a potential alternative for improving quality of life and cardiac function in a challenging patient population.
Background:
Biventricular pacing using a pacemaker lead located epicardially on the left ventricle, introduced via the coronary sinus to a coronary vein, and one pacemaker lead located endocardially at the apex of the right ventricle can resynchronize the contraction of the left ventricle. Approximately 30-50% of patients with severe heart failure have left bundle branch block indicating asynchronous contraction of the left ventricle. These patients can have a significant haemodynamic benefit from biventricular pacing.
Material And Methods:
The methods for implanting the leads are described. Biventricular pacemakers were implanted in five patients.
Results:
Acceptable low thresholds for pacing the left ventricle were achieved. Resynchronization of the contraction of the left ventricle was demonstrated by using colour tissue Doppler measurements. The mechanisms for the haemodynamic benefit of biventricular pacing are discussed on the basis of our data. The first patient has been followed for 12 months. He has a lasting improvement in functional capacity from class IV to class II, marked reduction of the left ventricular size, and improvement of the left ventricular ejection fraction from 15% to 38%.
Interpretation:
The results are promising for patients who, because of lack of donor hearts and age criteria, often cannot be offered heart, transplantation.