Biventricular pacing for heart failure patients on inotropic support: a review of 38 consecutive cases

Biventricular pacing (BiV) has documented benefit in New York Heart Association functional class III patients. Whether BiV offers benefit to class IV patients on inotropic therapy is unclear. Retrospective review was performed on 38 consecutive heart failure patients who received BiV while on inotropic support or within 30 days of inotropic administration; the mean age was 63 +/- 13 yrs; 9 were women. Fourteen who received inotropic agents did so in conjunction with coronary artery bypass grafting, or valve or infarct exclusion surgery. Twenty-three patients received inotropic therapy only before BiV Nine other patients received inotropic therapy before BiV and at another point (5 at implant and 4 after BiV); 6 were on inotropic support only at implant. Mean follow-up was 1.2 +/- 0.9 years. There were 14 deaths. Survival estimates at 6 months, 1 year, and 2 years were 74%, 71%, and 61%, respectively. When patients on inotropic therapy before BiV (n=32) were compared with patients never on such therapy before BiV (n=6), there was a survival difference (P <0.0001); all 6 patients not on inotropic therapy before BiV died within the first 2 years. Estimated 6-month and 1-year survival for those on inotropic support before BiV was 84 % and 81 %, compared with 23% and 23% for the other group. Patients who required inotropic agents only before BiV fared better than those requiring inotropic support at other times. Although the patients in this survey were a very high-risk group, a small subset was weaned and had stable short-term survival.