Background: The complications and limitations of biventricular pacing largely relate to left ventricular (LV) pacing. An alternative approach was tested of simultaneously pacing the right ventricular (RV) apex and outflow tract (RVOT) or using bifocal right ventricular pacing (BRVP) to provide cardiac resynchronisation.
Methods: 21 consecutive patients with heart failure and severely impaired left ventricular function were studied. Ejection fraction and tissue Doppler data were collected at baseline, during BRVP, and during biventricular pacing, using a temporary pacing protocol.
Results: BRVP was achieved in all patients without complication. BRVP significantly reduced mean baseline intra-LV, inter-LV–RV, and global mechanical dyssynchrony from (mean (SD)) 71 (35) to 44 (18) ms, p = 0.003; 86 (42) to 57 (33) ms, p = 0.029; and 157 (67) to 101 (42) ms, p = 0.005, respectively. It increased the ejection fraction from 21 (8)% to 29 (7)%, p = 0.002. Compared with BRVP, reductions in intra-LV, inter-LV–RV, and global mechanical dyssynchrony were superior with biventricular pacing (31 (12) ms, p = 0.014; 36 (27) ms, p = 0.008; and 67 (34) ms, p = 0.01 compared with BRVP, respectively); improvements in ejection fraction were similar (26 (9)%, NS).
Conclusions: In patients with heart failure, superior mechanical resynchronisation is achieved with biventricular pacing compared with BRVP. BRVP may be useful when left ventricular lead placement is not possible.
- biventricular pacing
- bifocal right ventricular pacing
- ventricular dyssynchrony
- tissue Doppler imaging
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Competing interests: REL received a research grant from Medtronic Inc. and has received sponsorship to attend scientific meetings from Medtronic Inc. and Guidant Corporation. JM is a consultant on two research grants from Medtronic Inc. and has received sponsorship to attend scientific meetings from Medtronic Inc. NSP has received sponsorship to attend scientific meetings from Medtronic Inc. and Guidant Corporation. DWD is a consultant on two research grants from Medtronic Inc. He has received sponsorship to attend scientific meetings from Medtronic In. and St Jude Medical. He is on the advisory board for St Jude Medical Atrial Fibrillation Division. His partner is an employee of Medtronic Inc. AWCC is a consultant on a research grant from Guidant Corporation. He has received sponsorship to attend scientific meetings from Medtronic Inc., Guidant Corporation and St Jude Medical.