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ESC Congress 2003: Left ventricular pacing alone has similar benefits to those of biventricular pacing in patients with severe heart failure

September 01, 2003

IMPORTANT: This press release accompanies a poster or oral session given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology

Our study shows that left ventricular and biventricular pacing provide similar improvement of the main mechanisms of benefit of cardiac resynchronisation: synchrony of the left and right ventricle (inter-ventricular synchrony), synchrony of the different segments of the left ventricle (intra-ventricular synchrony), and severity of secondary mitral regurgitation. This might be important from a technical, economical, and safety point of view, since it is easier to implant two rather than three leads.

We studied sixteen consecutive patients with a biventricular InSync III (Medtronic Inc, Minneapolis) pacemaker. Patients were studied during sinus rhythm (unpaced), during left ventricular pacing, and during biventricular pacing, 3.6â€žb2.2 months after pacemaker implantation. Three patients (19%) were in New York Heart Association functional class 2, 12 patients (75%) were in class 3, and 1 patient (6%) was in class 4. Aetiology of heart failure was ischaemic in 11 patients (70%) and non-ischaemic in 5 patients (30%).

Conventional transthoracic echocardiography was performed during each stage, to assess global systolic and diastolic left ventricular function and mitral valve morphology and function. Regional left ventricular function was assessed from the myocardial systolic velocities, and mechanical ventricular synchrony was calculated from regional systolic timings, using tissue Doppler.

We calculated and compared the changes from baseline for both pacing modalities. Since both left ventricular and biventricular pacing decrease intraventricular asynchrony similarly (figure 1), it is logical that they should have similar effects on cardiac function. And indeed, we showed that both regional and global systolic parameters were improved to the same degree by both pacing modes. Both pacing modes also changed the diastolic inflow pattern similarly, increasing the filling time, and decreasing the estimated left ventricular filling pressure. Severity of secondary mitral regurgitation was also decreased by the same degree (about 30%) by both pacing modalities.

Left ventricular pacing was more effective than biventricular pacing in coordinating regional contraction between left ventricle and right ventricle; in 63% of patients, left ventricular pacing caused the left ventricle to reach peak systolic velocity before the right ventricle, whereas during biventricular pacing, the left ventricle reached peak systolic velocity before the right ventricle in only 31% of the patients.

In conclusion, left ventricular and biventricular pacing have similar acute effects, suggesting that in some patients left ventricular pacing alone may be sufficient for clinical benefit. This should now be tested in long-term studies.

Dr Dragos Vinereanu, FESC
Wales Heart Research Institute
United Kingdom

European Society of Cardiology (ESC)

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