PMID- 11992131
OWN - NLM
STAT- MEDLINE
DCOM- 20020529
LR  - 20191210
IS  - 0828-282X (Print)
IS  - 0828-282X (Linking)
VI  - 18
IP  - 4
DP  - 2002 Apr
TI  - Biventricular pacing improves quality of life and exercise tolerance in patients 
      with heart failure and intraventricular conduction delay.
PG  - 380-7
AB  - BACKGROUND: Biventricular pacing improves left ventricular dysynchrony, leading 
      to improvement in congestive heart failure symptoms. The extent of placebo 
      effect, the predictors of response and the long term benefits are unknown. 
      PATIENTS AND METHODS: Forty-five patients with symptomatic congestive heart 
      failure underwent implantation of a biventricular pacing system over a 30-month 
      period (age 65 10 years, 37 men). Patients underwent implantation of a 
      biventricular pacemaker or implantable defibrillator one month or longer after 
      stabilization of congestive heart failure on maximal medical therapy, including 
      angiotensin-converting enzyme inhibitors in 84% of patients and beta-blockers in 
      56% of patients. Three patients had New York Heart Association (NYHA) class II 
      heart failure, 34 had NYHA class III and eight had NYHA class IV. Cardiomyopathy 
      was ischemic in 31 patients, dilated in 12 and the result of other causes in two. 
      The left ventricular ejection fraction was 19 5%. RESULTS: Implantation of the 
      biventricular pacing system was successful in 38 of 45 patients (84%). Two 
      patients had successful implantation with a second attempt, and one patient had 
      an epicardial lead implant. Lead dislodgement occurred in four patients, with 
      successful repositioning in all. During a mean follow-up of 10 7 months, the 
      Minnesota Living with Heart Failure Questionnaire quality of life index score 
      improved from 62 16 to 42 22 at one month (P<0.001), but subsequently returned to 
      intermediate levels (55 26 at three months, 48 26 at six months and 56 34 at one 
      year, P=0.50). In seven patients with deferred device activation, quality of life 
      scores also improved by 10 15 points from baseline to one month with VDI 35 
      pacing, and improved a further 15 20 points with left ventricular lead 
      activation. The mean NYHA class fell from 3.1 0.5 at baseline to 2.7 0.7 at one 
      month (P=0.006) and remained stable thereafter (2.8 0.9 at three months, 2.8 0.9 
      at six months). Six patients died during follow-up, one patient had a cardiac 
      transplantation and subsequently died, one patient had a successful cardiac 
      transplantation and one patient underwent insertion of a left ventricular assist 
      device. Death occurred due to progressive heart failure in five patients, sudden 
      death occurred in one patient and a noncardiovascular cause resulted in the death 
      of one patient. An analysis of NYHA responders (NYHA class improvement of 1 or 
      more at last follow-up, 44% of patients) and quality of life responders (score 
      improvement of 10 or more at last follow-up, 57% patients) did not show any 
      difference in age, sex, heart failure etiology, QRS width, ejection fraction or 
      baseline NYHA class. CONCLUSIONS: Biventricular pacing improves quality of life 
      and NYHA class in patients with advanced heart failure and intraventricular 
      conduction delay. The attenuated benefit seen over time may be related to initial 
      placebo effect or simple dual- chamber pacing, or the natural history of the 
      underlying disease. Identification of patients most likely to respond to 
      biventricular pacing was not possible.
FAU - Krahn, Andrew D
AU  - Krahn AD
AD  - London Health Sciences Centre, University Campus, London, Canada. akrahn@uwo.ca
FAU - Snell, Laura
AU  - Snell L
FAU - Yee, Raymond
AU  - Yee R
FAU - Finan, Jane
AU  - Finan J
FAU - Skanes, Allan C
AU  - Skanes AC
FAU - Klein, George J
AU  - Klein GJ
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
MH  - Aged
MH  - Arrhythmias, Cardiac/*therapy
MH  - Cardiac Pacing, Artificial/*methods
MH  - *Exercise Tolerance
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pacemaker, Artificial
MH  - *Quality of Life
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
EDAT- 2002/05/07 10:00
MHDA- 2002/05/30 10:01
CRDT- 2002/05/07 10:00
PHST- 2002/05/07 10:00 [pubmed]
PHST- 2002/05/30 10:01 [medline]
PHST- 2002/05/07 10:00 [entrez]
PST - ppublish
SO  - Can J Cardiol. 2002 Apr;18(4):380-7.