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Left ventricular pacing alone improves haemodynamic variables

Introduction

Despite advances in drug treatment, congestive heart failure (CHF) remains a major healthcare problem associated with a poor quality of life and a high mortality rate. During the past decade, cardiac resynchronisation therapy (CRT) using biventricular (BIV) pacing emerged as a promising technique improving the quality of life, exercise tolerance and mortality in patients with severe CHF. Left univentricular (LV) pacing is able to achieve the same mechanical synchronisation as BIV pacing in experimental studies and in humans resulting in significant improvement in functional class, quality of life and exercise tolerance at the same extent as those observed with BIV stimulation. The aim was to study the acute hemodynamic effects of LV pacing in the category of patients with severe CHF and QRS duration <130 ms and to determine whether pulmonary capillary wedge pressure (PCWP) >15 mmHg could have an impact on these changes in hemodynamics.

Methods

We conducted an acute study on 20 patients (15 male, five female; mean age 43 years); all had CHF (12 ischemic and eight idiopathic) with a QRS duration <130 ms. All patients had an ejection fraction <40%. Group I comprised 10 patients with PCWP >15 mmHg, group II comprised 10 patients with PCWP <15 mmHg. Haemodynamics were measured using a Swan–Ganz catheter at baseline and during LV VDD pacing. All patients were under maximal tolerated doses of antifailure treatment.

Results

After LV pacing, group I showed a significant decrease in right atrial pressure (P = 0.001), and PCWP also significantly decreased (P = 0.0001), while the cardiac output ignificantly increased (P = 0.04). In group II none of these hemodynamic parameters showed any significant improvement. The improvement of hemodynamics in group I occurred despite the greater increase in QRS duration after LV pacing when compared with group II (24 vs. 21%, respectively).

Conclusion

LV pacing acutely benefits CHF patients with PCWP >15 mmHg irrespective of the QRS duration. Although this is an acute study, our findings open the scope for revising the current wide QRS duration as an indication for CRT and to consider the less expensive LV rather than BIV pacing when a patient is considered a candidate for resynchronization.

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Rgab, D. Left ventricular pacing alone improves haemodynamic variables. Crit Care 13, P156 (2009). https://doi.org/10.1186/cc7320

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Keywords

  • Congestive Heart Failure
  • Cardiac Resynchronisation Therapy
  • Pulmonary Capillary Wedge Pressure
  • Exercise Tolerance
  • Ventricular Pace