Usefulness of bifocal pacing in patients with heart failure and intraventricular conduction delay.

Abstract:

BACKGROUND:Bifocal pacing (BFP) has been proposed as a feasible alternative to cardiac resynchronization therapy. AIM:To evaluate BFP in patients with severe heart failure and significant intraventricular conduction delay and to compare it with biventricular pacing (BVP). METHODS:Echocardiographic examination including TDI and invasive measurement of haemodynamics was performed under basal conditions, during BFP and during BVP. RESULTS:Fifty patients were included: 29 with ischaemic heart disease (IHD), 21 with idiopathic dilated cardiomyopathy (IDCM). LV dp/dt(max) increased during BFP compared to the basal state (13.4%, 95% CI 9.2-17.6%, p<0.0001) and a further increase was achieved during BVP (29.5%, 95% CI 23.7-35.4%, p<0.0001). A significant correlation was found between the distance of the right ventricular apical and outflow tract leads and percentage of dp/dt(max) increase in IDCM patients (r=0.72), but not in IHD patients. Interventricular mechanical delay (IVMD) decreased in BFP (43+/-22 ms vs. 53+/-31 ms, p=0.006), but BVP produced even shorter IVMD (22+/-19 ms, p<0.0001). In all patients, regional systolic contraction times were significantly shortened, corresponding with prolongation of the respective regional diastolic filling times during both BFP (p<0.05 for all segments) and BVP (p<0.001 for all segments). CONCLUSIONS:BFP improves LV haemodynamics by decreasing the inter- and intraventricular conduction delays. The leads in the right ventricle should be placed at the longest achievable distance. BVP is superior to BFP.

journal_name

Eur J Heart Fail

authors

Bulava A,Lukl J

doi

10.1016/j.ejheart.2006.09.003

subject

Has Abstract

pub_date

2007-03-01 00:00:00

pages

300-5

issue

3

eissn

1388-9842

issn

1879-0844

pii

S1388-9842(06)00248-0

journal_volume

9

pub_type

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