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European Journal of Heart Failure 2007 9(3):300-305; doi:10.1016/j.ejheart.2006.09.003
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© 2007 European Society of Cardiology

Usefulness of bifocal pacing in patients with heart failure and intraventricular conduction delay

Alan Bulava* and Jan Lukl

1st Department of Internal Medicine, University Hospital and Faculty of Medicine Palacky University, Olomouc, Czech Republic

* Corresponding author. I. P. Pavlova 6, 775 20 Olomouc, Czech Republic. Tel.: +420 588443201; fax: +420 588442500. E-mail address: alanbulava{at}seznam.cz


  Abstract

Background: Bifocal pacing (BFP) has been proposed as a feasible alternative to cardiac resynchronization therapy.

Aim: To evaluate BFP in patients with severe heart failure and significant intraventricular conduction delay and to compare it with biventricular pacing (BVP).

Methods: Echocardiographic examination including TDI and invasive measurement of haemodynamics was performed under basal conditions, during BFP and during BVP.

Results: Fifty patients were included: 29 with ischaemic heart disease (IHD), 21 with idiopathic dilated cardiomyopathy (IDCM). LV dp/dtmax increased during BFP compared to the basal state (13.4%, 95% CI 9.2–17.6%, p<0.0001) and a further increase was achieved during BVP (29.5%, 95% CI 23.7–35.4%, p<0.0001). A significant correlation was found between the distance of the right ventricular apical and outflow tract leads and percentage of dp/dtmax increase in IDCM patients (r=0.72), but not in IHD patients. Interventricular mechanical delay (IVMD) decreased in BFP (43±22 ms vs. 53±31 ms, p=0.006), but BVP produced even shorter IVMD (22±19ms, p<0.0001). In all patients, regional systolic contraction times were significantly shortened, corresponding with prolongation of the respective regional diastolic filling times during both BFP (p<0.05 for all segments) and BVP (p<0.001 for all segments).

Conclusions: BFP improves LV haemodynamics by decreasing the inter- and intraventricular conduction delays. The leads in the right ventricle should be placed at the longest achievable distance. BVP is superior to BFP.

Key Words: Cardiac resynchronization • Bifocal pacing • Biventricular pacing • Haemodynamics

Received March 3, 2006; Revised June 8, 2006; Accepted September 8, 2006


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