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Thorac Cardiovasc Surg 2002; 50(2): 67-70
DOI: 10.1055/s-2002-26702
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Biventricular Pacing in Patients with ICD: How Many Patients are Possible Candidates?

C.  Werling1 , U.  Weiße1 , G.  Siemon2 , A.-H.  Kiessling1 , M.  Rameken2 , H.  Schwacke2 , W.  Saggau1 , J.  Senges2 , K.  Seidl2
  • 1Klinik für Herzchirurgie, Herzzentrum Ludwigshafen, Germany
  • 2Klinik für Kardiologie, Herzzentrum Ludwigshafen, Germany
This paper was presented at the German Society for Thoracic and Cardiovascular Surgery conference on February 16th, 2000 in Leipzig, Germany.
Further Information

Publication History

February 19, 2001

Publication Date:
30 April 2002 (online)

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Abstract

Background: About 80 % of patients receiving an implantable cardioverter-defibrillator (ICD) due to life-threatening episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) have structural heart disease. ICD implantation reduces the risk of sudden cardiac death to less than 2 %. However, the major obstacle in these patients is chronic heart failure (CHF). Biventricular stimulation (BIV) has shown its efficiency as an alternative therapy in drug refractory CHF. Methods: According to the InSync registry, we predefined possible indications for BIV as follows: complete branch bundle block (> 120 ms), left-ventricular ejection fraction (EF) < 35 % and NYHA class > II. We evaluated the number of patients presenting this indication at time of implant and during follow-up (FU) at our ICD clinic. Results: Between 1992 and 1998, 360 patients were provided with an ICD (mean age 64.6 ± 5.4 yrs, mean EF 37 ± 14 % at implant, 82 % of patients with organic heart disease). Mean FU was 34 ± 21 months. During FU 46 patients (13 %) died, 15 of these (33 %) presenting criteria for BIV. 33 patients died of heart failure, there was 1 sudden death and 12 patients died for non-cardiac reasons. 35 % of the patients who died of heart failure had an indication for BIV. Conclusions: About 10 % of ICD patients had an indication for BIV at time of implant. Over a mean FU period of 34 months, 16% of all patients presented an indication for BIV. Patients with an indication for BIV had a higher mortality rate and more frequent atrial fibrillation compared to patients without. With this data and the good clinical results after BIV-ICD implantation, we consider the implantation of a BIV-ICD system in every patient with appropriate indications.

Key words

Biventricular pacing - ICP - Indication

References

  • 1 Gras D, Mabo P, Tang T, Luttikuis O, Chatoor R, Pedersen A-K, Tscheliessnigg K-H, Deharo J-C, Puglisi A, Silvestre J, Kimber S, Ross H, Ravazzi A, Paul V, Shehan D. Multisite Pacing as a supplemental Treatment of congestive heart failure: Preliminary results of Medtronic Inc.  Insync study PACE. 1998;  21 (II) 2249-2255
    PubMedGoogle Scholar
  • 2 Kerwin W F, Botvinick E H, O'Conell J W, Merrick S H, DeMarco T, Chatterjee K, Saxon L A. Biventricular Pacing: acute improvements in ejection fraction correspond with measures of improved RV/LV synchrony.  Archives des maladies du coeur et de vaisseaux. 1998;  91 (III) 152
    PubMedGoogle Scholar
  • 3 The S OLVD . Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure.  N Engl J Med. 1991;  325 293-302
    CrossrefPubMedGoogle Scholar
  • 4 Gradman A, Deedwania P, Cody R, Massie B, Pitt B, Goldstein S. Predictors of total mortality and sudden death in mild to moderate heart failure.  J Am Coll Cardiol. 1989;  14 564-570
    PubMedGoogle Scholar
  • 5 Wilson J R, Schwartz J S, Sutton M, Ferraro N, Horowitz L N, Reichek N, Josephson M E. Prognosis in heart failure: relation to hemodynamic measurements and ventricular ectopic activity.  J Am Coll Cardiol. 1983;  2 403-410
    PubMedGoogle Scholar
  • 6 Kjekshus J. Arrhythmias and mortality in congestive heart failure.  Am J Cardiol. 1990;  65 421-481
    PubMedGoogle Scholar
  • 7 Brecker S JD, Xiao H B, Sparrow J, Gibson D G. Effects of dual chamber pacing with short atrioventricular delay in dilated cardiomyopathy.  Lancet. 1992;  340 1308-1312
    CrossrefPubMedGoogle Scholar
  • 8 Innes D, Leitch J W, Fletscher P J. VDD pacing at short atrio ventricular intervals does not improve cardiac output in patients with dilated heart failure.  PACE. 1994;  17 (I) 959-965
    PubMedGoogle Scholar
  • 9 Nishimura R A, Hayes D L, Holmes D R, Tajik A J. Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction: an acute Doppler and catheterisation hemodynamic study.  J Am Coll Cardiol. 1995;  25 281-288
    CrossrefPubMedGoogle Scholar
  • 10 Leclercq C, Pavin D, Carre F, Victor F, Le Breton H, Gras D, Mabo P, Daubert C. Permanent biventricular pacing improves exercise tolerance in patients with end-stage congestive heart failure.  Archives des maladies du Coeur et des vaisseaux. 1998;  91 64
    PubMedGoogle Scholar
  • 11 Gras D, Leclercq C, Cazeau S, Ritter P, Mabo P, Lazarus A, Mugica J, Daubert C. Biventricular synchronization for heart failure: the VAL d'Or and Rennes experience.  Archives des maladies du Coeur et des vaisseaux. 1998;  91 (III) 154
    PubMedGoogle Scholar
  • 12 Bakker P. Biventricular pacing improves functional capacity in patients with end-stage congestive heart failure.  PACE. 1995;  18 825
    PubMedGoogle Scholar
  • 13 Leclercq C. Permanent biventricular pacing: a new alternative to treat end-stage congestive heart failure.  Circulation. 1997;  96 1-95
    PubMedGoogle Scholar
  • 14 Mahaux V, Demoulin J C, Pierard L, Soyeur D, Fourny J, Kulbertus H. Biventricular stimulation in congestive heart failure: initial clinical experience. Oto A Euro Pace Monduzzi Editore 1995 95: 533-536
    Google Scholar
  • 15 Leclercq C, Le Breton H, Pavin D, Victor F, Mabo P, Daubert J C. Acute hemodynamic response to biventricular DDD pacing in patients with severe congestive heart failure and without conventional indication to permanent pacemaker.  Circulation. 1997;  96 (8) 1-95
    PubMedGoogle Scholar
  • 16 Lamp B, Hammel D, Kerbe S. Multisite pacing in severe heart failure - how many patients are eligible?.  PACE. 1998;  21 (II) 973
    PubMedGoogle Scholar
  • 17 Appleton C P, Hatle L K, Popp R L. Relation of transmitral flow velocity to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study.  J Am Coll Cardio. 1988;  12 426-440
    PubMedGoogle Scholar
  • 18 Brecker S JD, Gibson D G. What is the role of pacing in dilated cardiomyopathy?.  Eur Heart J. 1996;  17 819-824
    PubMedGoogle Scholar
  • 19 Nishimura R A, Symanski J D, Hurrell D G, Trusty J M, Hayes D L, Tajik A L. Dual-chamber pacing for cardiomyopathies: a 1996 clinical perspective. Mayo Clin Proc 1996: 1077-1087
    Google Scholar
  • 20 Kataoka H. Hemodynamic effect of physiologic dual chamber pacing in a patient with end stage dilated cardiomyopathy: a case report.  PACE. 1991;  14 1330-1335
    PubMedGoogle Scholar
  • 21 Skinner N S, Mitchell J H, Wallace A G, Sarnoff S J. Hemodynamic effects of altering the timing of atrial systole.  Am J Physiol. 1963;  205 499-503
    PubMedGoogle Scholar
  • 22 Auricchio A, Sommariva L, Salo R W, Scafuri A, Chiariello L. Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual-chamber pacing with shortened AV delay.  PACE Pacing Clin Electrophysiol. 1993;  16 2034-2043
    PubMedGoogle Scholar
  • 23 Brecker S JD, Xiao H B, Sparrow J, Gibson D G. Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy.  Lancet. 1992;  340 1308-1312
    CrossrefPubMedGoogle Scholar
  • 24 Linde C, Gadler F, Edner M, Nordlander R, Rosenqvist M, Ryden L. Results of atrioventricular synchronous pacing with optimised delay in patients with severe congestive heart failure.  Am J Cardiol. 1995;  75 919-923
    CrossrefPubMedGoogle Scholar
  • 25 Gold M R, Feliciano Z, Gottlieb S S, Fisher M L. Dual-chamber pacing with short atrioventricular delay in congestive heart failure: a randomised study.  J Am Coll Cardiol. 1995;  26 967-973
    CrossrefPubMedGoogle Scholar

1

MD Christiane Werling

Klinik für Herzchirurgie, Herzzentrum Ludwigshafen

Bremserstrasse 79


67063 Ludwigshafen

Germany

Phone: +49 (621) 5 03 40 50

Fax: +49 (621) 5 03 40 60

Email: werlingc@klilu.de

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