Objective: Biventricular pacing (bv) is an effective tool for treatment of heart failure. The
present study estimates how many open heart-surgery pts may benefit from implantation
of permanent lv-pacing leads. A protocol for identifying potential responders was
established. It has to be investigated, if additional costs are justified.
Methods: To establish a protocol, 1059 pts were retrospectively investigated according to
lv-function, left BBB and QRS duration. Afterwards, adequate cardiosurgical pts were
selected out of 1420 consecutive pts and epicardial lv-leads (Medtronic 5071(ME) or
Enpath (EP)) were implanted with concomitant procedures. Mean follow-up time was 6.3±5.5
months, postoperative NYHA class was documented.
Results: Initially, 24 pts (2.3%) potentially would profit from bv-pacing. After establishing
our protocol, 22 pts (1.6%) were identified and finally received an epicardial lead.
No lead related complications occurred. Acute capture threshold was 0.9±0.4 V (ME,
n=17) and 0.5±0.2 V (EP, n=5). While leads in 18 Group A pts were implanted as an
upgrade of existing pacemaker or ICD technology, 4 Group B pts had prophylactic implantation
with no device attached. In 3 Group B pts (75%), bv-ICDs were implanted 1 to 12 months
postop. In Group A, QRS duration decreased (189±35 to 152±16ms, p<0.02) and postoperative
mean NYHA functional class improved significantly (2.2±0.5 versus 2.8±0.6).
Conclusion: A small group of cardiosurgical pts may benefit from lv-lead implantation with concomitant
cardiosurgical procedures. A protocol for responder- identification is useful. Existing
devices should be upgraded to bv-systems. As ICD-implantation is frequent, lv-leads
should be implanted routinely.
