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Comparison of the Effect of Only Left Ventricular Pacing and Biventricular Pacing in Heart Failure Patients with Complete Left Bundle Branch Block

Author: LiuRong
Tutor: WangDongMei
School: Dalian Medical University
Course: Internal Medicine
Keywords: Heart failure Complete left bundle branch block Left ventricular pacing Cardiac resynchronization therapy
CLC: R541.6
Type: Master's thesis
Year: 2011
Downloads: 4
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Abstract

Objective: The clinical outcomes of only left ventricular pacing in heart failure patients with complete left bundle branch block(CLBBB)has not been determined. The purpose of this study was to compare the short-term clinical outcomes of left ventricular pacing and biventricular pacing in heart failure patients with CLBBB.Methods: 24 heart failure patients with CLBBB who had received the cardiac resynchronization therapy(CRT)were involved in this study ,16 men and 8 women, 6 with CAD and 18 with NCAD, and the average age was 61.42±9.45 years. All of them were meet the class I indication of CRT in the ACC/AHA/HRS 2008 guidelines device based therapy cardiac rhythm abnormalities. All the patients were randomly divided into group I(12 patients, only left ventricular pacing first)and group II(12 patients, biventricular pacing first) with the anti-heart failure treatment simultaneously. Self curing ross-matching method was used in this study. NYHA classification, 6 minutes walk test(6-MWT), quality of life scores(QoL scores),ECG, echocardiography(Echo), and pacemaker follow-up evaluation were performed at baseline, after 3 mAcocnothrds i nagn tdo t6h e mfoolnlothws- uopf r eosnullyts oleff tp avtieennttrsi ctuol aard jupsatceidn gth ea nddru gb itvreeanttmriceunlta pr r opgarcaimngs,. recorded the causes and frequency of rehospitalization and mortality.Results: (1) All parameters were improved significantly 3 and 6 months in the two groups compared with before pacing therapy(P<0.05), and there were no re-hospital and death in all the patients. (2) Whether only left ventricular pacing or biventricular pacing, the size of the cardiac chambers, left ventricular ejection function and clinical symptoms were improved after pacing therapy and there were no statistical difference between the two groups(P>0.05). (3) Both the only left ventricular pacing and biventricular pacing had a better response to CRT and there was no difference in the response rate. But the heart function were worsening in 3 patients after only left ventricular pacing. The 6-MWT, QRS complex, NYHA classification, LAEDD, LVEDD and MR classification showed no significant difference between the two pacing modes(P>0.05). While, the left ventricular ejection fraction(LVEF)and quality of life scores were improved better in biventricular pacing patients than only left ventricular pacing(biventricular pacing vs only left ventricular pacing:△QoL: -28.08±22.97 vs -22.96±16.03, P=0.02;△LVEF: 17.29±11.80% vs 14.38±10.69%, P=0.04).Conclusions: Short-term outcomes showed that either with biventri- cular pacing or with only left ventricular pacing have a higher“response”rate in heart failure patients with CLBBB. Both the two pacing methods could improve cardiac function and activity tolerance in heart failure patients with CLBBB. But LVEF and quality of life scores were improved markedly by biventricular pacing than left ventricular pacing only. Therefore, for the financial reasons, the heart failure patients with CLBBB could be considered to implant with the general dual-chamber pacemaker which the ventricular electrode is implanted in the vein of the left ventricular epicardium. With this type of dual-chamber pacemaker the clinical outcomes were similar with the biventricular resynchronization therapy.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Blood circulation failure
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