Biventricular pacing doesn't improve left ventricular global systolic or diastolic function but only septal systolic contractility in patients with advanced heart failure and left bundle branch block

Biventricular pacing has revolutionised the treatment of heart failure in patients with sinus rhythm and left bundle branch block; however, left ventricular-lead placement is not always technically possible. Furthermore, biventricular pacing does not fully normalise ventricular activation and, therefore, the ventricular resynchronisation is imperfect. Right ventricular pacing for bradycardia may cause or worsen heart failure in some patients by causing dyssynchronous ventricular activation. His bundle pacing activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising alternate site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block. Furthermore, it may open up new indications for pacing therapy in heart failure, such as targeting patients with PR prolongation, but a narrow QRS duration. In this article we explore the physiology, technology and potential roles of His bundle pacing in the prevention and treatment of heart failure.

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806 Complications related to left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(05)80511-9 ◽

2005 ◽

Vol 4 (1) ◽

pp. 185-186

Keyword(s):

Heart Failure ◽

Biventricular Pacing ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Left Ventricular Lead ◽

Ventricular Lead

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Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure

Heart ◽

10.1136/hrt.85.5.514 ◽

2001 ◽

Vol 85 (5) ◽

pp. 514-520

Author(s):

W Y Kim ◽

P Søgaard ◽

P T Mortensen ◽

H Kjærulf Jensen ◽

A Kirstein Pedersen ◽

...

Keyword(s):

Heart Failure ◽

Biventricular Pacing ◽

Three Dimensional ◽

Left Ventricular ◽

Walking Distance ◽

Short Term ◽

Bundle Branch Block ◽

Patients With Heart Failure ◽

Dimensional Echocardiography ◽

Three Dimensional Echocardiography

OBJECTIVESTo quantify the short term haemodynamic effects of biventricular pacing in patients with heart failure and left bundle branch block by using three dimensional echocardiography.DESIGNThree dimensional echocardiography was performed in 15 consecutive heart failure patients (New York Heart Association functional class III or IV) with an implanted biventricular pacing system. Six minute walk tests were performed to investigate the effect of biventricular pacing on exercise capacity. Data were acquired at sinus rhythm and after short term (2–7 days) biventricular pacing.RESULTSCompared with baseline values, biventricular pacing significantly reduced left ventricular end diastolic volume (EDV) by mean (SD) 4.0 (5.1)% (p < 0.01) and end systolic volume (ESV) by 5.6 (6.4)% (p < 0.02). Mitral regurgitant fraction was significantly reduced by 11 (12.1)% (p < 0.003) and forward stroke volume (FSV) increased by 13.9 (18.6)% (p < 0.02). Exercise capacity was significantly improved with biventricular pacing by 48.4 (43.3)% (p < 0.00001). Regression analyses showed that the percentage increase in FSV independently predicted percentage improvement in walking distance (r2 = 0.73, p < 0.0002). Both basal QRS duration and QRS narrowing predicted pacing efficacy, showing a significant correlation with %ΔEDV, %ΔESV, and %ΔFSV.CONCLUSIONSIn five of 15 consecutive patients with heart failure and left bundle branch block, biventricular pacing induced a more than 15% increase in FSV, which predicted a more than 25% increase in walking distance and was accompanied by an immediate reduction in left ventricular chamber size and mitral regurgitation.

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