(Circulation. 2000;102:3053.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Left Ventricular or Biventricular Pacing Improves Cardiac Function at Diminished Energy Cost in Patients With Dilated Cardiomyopathy and Left Bundle-Branch Block
From the Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Md. Dr Spinelli is now at Guidant, St. Paul, Minn.
Correspondence to David A. Kass, MD, Halsted 500, The Johns Hopkins Hospital, 600 N. Wolfe St, Baltimore, MD 21287. E-mail dkass{at}bme.jhu.edu
Background—Left ventricular or biventricular pacing/stimulation can acutely improve systolic function in patients with dilated cardiomyopathy (DCM) and intraventricular conduction delay by resynchronizing contraction. Most heart failure therapies directly enhancing systolic function do so while concomitantly increasing myocardial oxygen consumption (MVO2). We hypothesized that pacing/stimulation, in contrast, incurs systolic benefits without raising energy demand.
Methods and Results—Ten
DCM patients with left bundle-branch block (ejection fraction 20±3%,
QRS duration179±3 ms, mean±SEM) underwent cardiac
catheterization to measure ventricular and
aortic pressure, coronary blood flow,
arterial–coronary sinus oxygen difference
(
AVO2), and
M
O2. Data were measured under sinus
rhythm or with left ventricular or
biventricular pacing/stimulation at the same heart rate.
These results were then contrasted to intravenous
dobutamine (n=7) titrated to match systolic changes
during LV pacing. Systolic function rose quickly and
substantially from LV pacing (18±4% rise in arterial
pulse pressure, which correlates with cardiac output, and 43±6%
increase in dP/dtmax; both
P<0.01). However,
AVO2 and MO2
declined -4±2% and -8±6.5%, respectively (both
P<0.05). Similar results were
obtained with biventricular activation. In contrast,
dobutamine raised dP/dtmax 37±6%,
accompanied by a 22±11% rise in per-beat
MO2
(P<0.05 versus
pacing).
Conclusions—Ventricular resynchronization by left ventricular or biventricular pacing/stimulation in DCM patients with left bundle-branch block acutely enhances systolic function while modestly lowering energy cost. This should prove valuable for treating DCM patients with basal dyssynchrony.
Key Words: heart failure • bundle-branch block • pacing • oxygen
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