[Chronic simultaneous stimulation of both ventricles, a new treatment option for severe congestive heart failure]

Dilated congestive heart failure due to systolic left ventricle dysfunction frequently leads to intraventricular conduction disturbances with a prolonged QRS complex (> 120 ms). The prolonged conduction time in the ventricles causes electrical asynchrony of the ventricles and contributes to a further reduction of systolic function, changes of filling and relaxation intervals, and promotes mitral valve insufficiency. Chronic simultaneous stimulation of both the right and left ventricle in patients with severe heart failure improves functional status, quality of life, and exertion tolerance. At present the implantation of a biventricular pacemaker is time consuming because the positioning of the lead in a left ventricular epicardial vein is difficult. As congestive heart failure is frequently associated with an increased risk of ventricular fibrillation, the combined implantation of a biventricular stimulator and an implantable automatic defibrillator is sometimes necessary. Preliminary calculations show that about 750 patients per year with severe congestive heart failure are eligible for a biventricular stimulator.