Abstract 3186: A Randomized Study of Biventricular versus Left Univentricular Pacing in Heart Failure: Left Or Left And Right Ventricular pacing for Optimal Symptomatic Effect (LOLA ROSE) Study
Background Both biventricular (BiV) and left univentricular (LUV) pacing have been shown to produce sustained clinical benefits in patients with heart failure. Recent developments now permit independent programming of right and left ventricular leads, allowing sequential rather than simultaneous BiV pacing. Data comparing contemporary BiV pacing with LUV pacing are lacking.
Methods and Results We enrolled subjects with refractory heart failure symptoms despite optimal tolerated medication, sinus rhythm, LBBB and QRS duration>120ms. A randomized, blinded cross-over design was employed, with arms consisting of 8 +/− 1 weeks of BiV pacing and 8 +/− 1 weeks of LUV pacing. In each of these modes, optimization of pacing parameters was performed using transthoracic echocardiography. Paired data were collected on 18 patients: mean age 72.2 +/− 8.3 years; 16 male. In 14 patients, underlying cause of heart failure was IHD, in the remaining 4 patients DCM. Endpoints and Results are shown in the Table⇓ below. NYHA score was significantly better with BiV rather than LUV pacing. Maximal oxygen consumption (on bicycle exercise testing), 6 minute walk distance and score on SF-36 symptom questionnaire did not differ significantly between BiV and LUV pacing. Both BiV and LUV pacing produced superior results with regard to endpoints compared to baseline. There was no statistical evidence of carry-over effect between the 2 pacing modes for any of the endpoints.
Conclusion Left univentricular pacing offers clinical benefits which are comparable to biventricular pacing in patients with heart failure, sinus rhythm, LBBB and broad QRS complexes, over the short-to-medium term.