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Usefulness of bifocal pacing in patients with heart failure and intraventricular conduction delay
Author(s) -
Bulava Alan,
Lukl Jan
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2006.09.003
Subject(s) - medicine , cardiology , ventricle , heart failure , cardiac resynchronization therapy , hemodynamics , basal (medicine) , endocardium , diastole , ejection fraction , blood pressure , insulin
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 d p /d t 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 d p /d t 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±19ms, 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.