Published Online
on March 15, 2004

A more recent version of this article appeared on April 13, 2004

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Submitted on April 30, 2003
Revised on January 8, 2004
Accepted on January 12, 2004

Midterm Benefits of Left Univentricular Pacing in Patients With Congestive Heart Failure

Jean-Jacques Blanc MD^*, Valérie Bertault-Valls MD, Marjaneh Fatemi MD, Martine Gilard MD, Pierre-Yves Pennec MD, and Yves Etienne MD

From Brest University Hospital, Brest, France.

^* To whom correspondence should be addressed. E-mail: jean-jacques.blanc{at}univ-brest.fr.

Background--Resynchronization therapy by simultaneous pacing of the right and left ventricles has gained wide acceptance as a useful treatment for patients with severe congestive heart failure. Several short-term hemodynamic studies in humans and animals failed to demonstrate any benefit of biventricular pacing over left univentricular pacing, but long-term studies on this pacing mode are lacking. The objective of this study was to assess the outcome over a 1-year period of patients paced exclusively in the left ventricle.

Methods and Results--Clinical, angiographic, echocardiographic, and ergometric data were collected at baseline and after 12 months in 22 patients (age, 69.3±6.5 years) with NYHA class III or IV (10 patients), sinus rhythm, left bundle-branch block, and no bradycardia indication for pacing. After 12 months, compared with baseline values, NYHA class improved significantly by 40% (P<0.0001), 6-minute walk distance by 30% (P=0.01), peak VO₂ by 26% (P=0.01), left ventricular end-diastolic diameter by 5% (P=0.02), ejection fraction by 22% (P=0.07), mitral regurgitation area by 40% (P=0.01), and norepinephrine level by 37% (P=0.04).

Conclusions--In patients with severe congestive heart failure, sinus rhythm, and left bundle-branch block despite optimal pharmacological treatment, left univentricular pacing is feasible and results in significant midterm benefit in exercise tolerance and left ventricular function.

Key words: heart failure • pacing • prognosis

Related Article:

Single Site Left Ventricular Pacing for Cardiac Resynchronization

William G. Stevenson and Michael O. Sweeney
Circulation 2004 109: 1694-1696. [Extract] [Full Text]

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