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Long-term left ventricular pacing: assessment and comparison with biventricular pacing in patients with severe
Insights
Permanent left ventricular (LV) pacing showed a trend toward improvement in severe congestive heart failure (CHF) and left bundle branch block (LBBB) patients. Both LV and biventricular (BiV) pacing offered similar clinical outcomes at six months.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Left ventricular (LV) pacing alone demonstrated acute hemodynamic improvements comparable to biventricular (BiV) pacing in advanced congestive heart failure (CHF) with left bundle branch block (LBBB).
- Clinical outcomes of permanent LV pacing versus BiV pacing in this patient population remain unevaluated.
Purpose of the Study:
- To prospectively report six-month follow-up results of permanent LV-based pacing in severe CHF and LBBB patients.
- To compare the clinical outcomes of LV pacing alone versus BiV pacing.
Main Methods:
- Thirty-three patients with advanced CHF and LBBB were enrolled.
- Pacing configuration (LV or BiV) was determined by physician preference.
- Patient evaluations were conducted at baseline and six-month follow-up.
Main Results:
- Baseline characteristics were similar between the LV (18 patients) and BiV (15 patients) groups.
- At six months, no significant difference in New York Heart Association class I or II was observed between groups (p = 0.39).
- A significant difference was noted in LV end-diastolic diameter decrease, with greater reduction in the BiV group (-4.4 mm) compared to the LV group (-0.7 mm; p = 0.04).
Conclusions:
- Permanent LV-based pacing showed a trend toward objective parameter improvement in severe CHF and LBBB patients at six months.
- Both LV and BiV pacing modes resulted in comparable improvements in subjective and objective parameters.
Objective:
The purpose of this study is to report prospectively the results of six-month follow-up of permanent left ventricular (LV) based pacing in patients with severe congestive heart failure (CHF) and left bundle branch block (LBBB).
Background:
Left ventricular pacing alone has been demonstrated to result in identical improvement compared to biventricular pacing (BiV) during acute hemodynamic evaluation in patients with advanced CHF and LBBB. However, to our knowledge, the clinical outcome during permanent LV pacing alone versus BiV pacing mode has not been evaluated.
Methods:
Pacing configuration (LV or BiV) was selected according to the physician's preference. Patient evaluation was performed at baseline and at six months.
Results:
Thirty-three patients with advanced CHF and LBBB were included. Baseline characteristics of LV (18 patients) and BiV (15 patients) pacing groups were similar. During the six-month follow-up period, seven patients died three BiV and four LV). In the surviving patients at 6 months, 8 of 14 patients in the LV group and 9 of 12 in the BiV group were in New York Heart Association class I or II (p = 0.39). No significant difference was observed between the two groups in terms of objective parameters except for LV end-diastolic diameter decrease (-4.4 mm in BiV group vs. -0.7 mm in LV group; p = 0.04).
Conclusion:
At six-month follow-up, a trend toward improvement was observed in objective parameters in patients with severe CHF and LBBB following LV-based pacing. The two pacing modes (LV and BiV) were associated with almost equivalent improvement of subjective and objective parameters.