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Effect of biventricular pacing on heart function evaluated by gated blood pool study in patients with end-stage heart
Witold Cholewiński1, Anna Tarkowska, Andrzej Kutarski
1Department of Nuclear Medicine, Medical University of Lublin, Poland. vitas@mp.pl
Insights
Biventricular pacing offers slight improvement in left ventricular ejection fraction (LVEF) for heart failure patients. This cardiac pacing method shows promise for end-stage heart failure management.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Biventricular pacing (BV) is a complementary therapy for severe heart failure.
- Evaluating the impact of synchronous biventricular stimulation on cardiac function is crucial.
Purpose of the Study:
- To assess the effect of biventricular pacing on heart function using gated blood pool study (GBP).
- To compare biventricular pacing outcomes with single-chamber stimulation and sinus rhythm.
Main Methods:
- Ten end-stage heart failure patients underwent long-term biventricular pacing.
- Gated blood pool study (GBP) with 99mTc-labeled RBCs was used to calculate LVEF and perform phase analysis.
Main Results:
- Biventricular pacing showed a significant increase in LVEF compared to sinus rhythm (21.6% vs. 20.1%).
- BV pacing demonstrated a positive phase shift between ventricles, similar to SR and RV stimulation.
- BV stimulation altered conduction, causing a delay in right ventricular contraction relative to the left ventricle compared to LV pacing.
Conclusions:
- Biventricular pacing provides a modest improvement in LVEF for heart failure patients.
- BV pacing is a promising therapeutic option for end-stage heart failure.
- Synchronous biventricular stimulation does not consistently reduce interventricular dyssynchrony, warranting further research.
Background:
Biventricular cardiac pacing has been used as a complementary form of therapy in patients with severe heart failure. The aim of this study was to evaluate the effect of the synchronous stimulation of both ventricles on the heart function measured by gated blood pool study (GBP).
Material And Methods:
Ten patients (9 men and 1 woman aged 53-74 years) with end-stage heart failure (HF) were studied. In all patients long-term biventricular pacing (BV) was applied. The obtained results were compared with single-chamber stimulation in 5 patients and with sinus rhythm (SR) in 8 patients. All patients underwent repeated GBP with RBC labelled with 740 MBq of 99 mTc-pertechnetate. The LVEF was calculated according to the standard method based on the count rates. Phase analysis was performed with the standard method using first Fourier element.
Results:
Clinically in almost all patients moderate to important symptomatic improvement has been observed. The analysis of LVEF values revealed that BV pacing resulted in significantly higher values only in comparison with SR (21.6% +/- 10.3 v. 20.1% +/- 10.1; p < 0.05). The phase shift between both ventricles by BV pacing was positive and similar to that obtained with SR and RV stimulation (14.0 degrees +/- 29.6 v. 13.4 degrees +/- 37.6 and 7.4 degrees +/- 26.5 v. 6.0 degrees +/- 17.1 respectively). However, in comparison with LV pacing, BV stimulation revealed a change of dominant conduction abnormalities with a delay of RV contraction in relation to LV (9.0 degrees +/- 17.5 v. -3.0 degrees +/- 11.4).
Conclusions:
Biventricular pacing results in slight improvement of LVEF in patients with heart failure and can be considered a promising approach in patients with end-stage heart failure. Synchronous stimulation of both ventricles not always results in decrease of interventricular shift, however that observation requires further studies on a larger population.
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