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Long‐Term Follow‐Up of Biventricular Pacing Using a Totally Endocardial Approach in Patients with End‐Stage Cardiac Failure
Author(s) -
PASQUIÉ J.L.,
MASSIN F.,
MACIA J.C.,
GERVASONI R.,
BORTONE A.,
CAYLA G.,
GROLLEAU R.,
LECLERCQ F.
Publication year - 2007
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2007.00599.x
Subject(s) - medicine , cardiology , heart failure , ejection fraction , coronary sinus , left bundle branch block , cardiac resynchronization therapy , qrs complex , heart transplantation , ischemic cardiomyopathy , cardiomyopathy , bundle branch block , coronary artery disease , electrocardiography
Background: Besides standard left ventricular (LV) stimulation via the coronary sinus, a transseptal approach allows left ventricular endocardial stimulation. We report our long‐term observations with biventricular stimulation, using a strictly endocardial system for patients presenting with severe congestive heart failure .Methods: Six patients with nonischemic cardiomyopathy (mean age = 60 ± 9.6 years, women) in New York Heart Association (NYHA) functional class III (n = 5) or IV, despite optimal drug therapy, and a mean LV ejection fraction of 24 ± 3%, underwent implantation of biventricular stimulation systems between April 1998 and March 1999. All presented with left bundle branch block and an increased LV end‐diastolic diameter (mean = 66 ± 5 mm). In all patients, a bipolar pacing lead was implanted in the lateral LV wall using a direct transseptal approach. After implantation, all patients received oral anticoagulation.Results: QRS duration decreased from 184 ± 22 ms to 108 ± 11 ms. NYHA functional class decreased to II in all patients within 1 month. Over a 85 ± 5 month follow‐up, two patients underwent cardiac transplantation, 2 and 4 years after device implantation, respectively; two patients died of end‐stage heart failure 4 years after system implantation; and two patients were alive in functional class II. One patient, who experienced syncope due to fast ventricular, underwent implantation of an ICD. One transient ischemic attack occurred in a patient whose anticoagulation was temporarily interrupted .Conclusions: Long‐term endocardial biventricular stimulation via a transseptal approach was safe and effective in this small population. This approach needs to be further compared with conventional epicardial pacing via the coronary sinus