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Effectiveness of resynchronization therapy in patients with end-stage heart failure

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Abstract

Biventricular pacing has been introduced to treat patients with end-stage heart failure, and short-term results of this technique are promising. Because data on longer follow-up are limited to 3-month follow-up, the sustained effect of biventricular pacing is unclear and long-term survival is unknown. Forty patients with end-stage heart failure in New York Heart Association (NYHA) functional class III or IV with left ventricular (LV) ejection fraction (EF) <35%, QRS duration >120 ms, and left bundle branch block morphology received a biventricular pacemaker. At baseline, and at 3 and 6 months after implantation, the following parameters were evaluated: NYHA class, Minnesota quality-of-life score, QRS duration on surface electrocardiogram, 6-minute walking distance, and LVEF. Long-term follow-up was obtained for up to 2 years. All clinical parameters improved significantly at 3 months and remained unchanged at 6-month follow-up. LVEF increased from 24 ± 9% to 34 ± 11%. Before implantation, patients were hospitalized (for congestive heart failure) an average of 3.9 ± 5.3 days/year compared with 0.5 ± 1.5 days/year after implantation. Long-term follow-up showed a survival of 87.5% at 2 years. Thus, biventricular pacing resulted in improvement of symptoms and quality of life, accompanied by improvement in 6-minute walking distance and LVEF. These effects were observed at 3 months after implantation and were maintained at 6-month follow-up. Moreover, 2-year survival was excellent.

Section snippets

Patients:

The traditional inclusion criteria for biventricular pacing were applied1: end-stage heart failure, New York Heart Assocation (NYHA) functional class III or IV, LV ejection fraction (EF) <35%, QRS duration >120 ms, or >200 ms for paced QRS (in patients with a previous pacemaker), and left bundle branch block morphology. Consecutive patients with ischemic and nonischemic etiology were included; etiology of heart failure was assessed by left- and right-sided heart catheterization and coronary

Patient population

Forty patients were included (31 men, mean age 64 ± 10 years). The mean NYHA class was 3.3 ± 0.5. According to the inclusion criteria, all patients had severe LV dysfunction, with a mean LVEF of 24 ± 9% (range 11% to 35%). Nineteen patients (48%) had heart failure of ischemic etiology and 21 (53%) of nonischemic etiology. Mean QRS duration on surface electrocardiogram ranged from 120 to 240 ms.

Pacemaker implantation

Eleven patients had previously undergone pacemaker implantation for conventional indications for

Discussion

Biventricular pacing in 40 patients with end-stage heart failure resulted in an improvement in symptoms (NYHA class) and quality of life, accompanied by improvement in more objective parameters including 6-minute walking distance and LVEF. These effects were observed at early follow-up (3 months after implantation) and were maintained at 6-month follow-up. In addition, annual hospitalization rates for heart failure decreased significantly after pacemaker implantation and excellent long-term

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