Biventricular Pacing: How to Predict the Clinical Response in the Single Patient?

  • M. Gulizia
Conference paper


Congestive heart failure (CHF) is one of the most widespread diseases of the Western world. Its prevalence is about 22.5 million people worldwide and 6.5 million in Europe (747 000 in Italy), with an incidence of 2 million patients/year in the world and 470 000/year in Europe (66 000 in Italy).


Cardiac Resynchronization Therapy Pulmonary Capillary Wedge Pressure NYHA Class Congestive Heart Failure Patient Biventricular Pace 


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  1. 1.
    Cohn JN, Johnson G, Ziesche S et al (1991) A comparison of enalapril with hydralazi-ne-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 325:303–310PubMedCrossRefGoogle Scholar
  2. 2.
    Captopril Multicenter Research Group (1983) A placebo-controlled trial of Captopril in refractory chronic congestive heart failure. J Am Coll Cardiol 2:755–763CrossRefGoogle Scholar
  3. 3.
    Stevenson WG, Stevenson LW, Middlekauff HR et al (1996) Improving survival for patients with atrial fibrillation and advanced heart failure. J Am Coll Cardiol 28:1458–1463PubMedCrossRefGoogle Scholar
  4. 4.
    Aaronson KD, Schwartz S, Chen T-M et al (1997) Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 95:2660–2667PubMedCrossRefGoogle Scholar
  5. 5.
    Opie LH (1995) Fundamental role of angiotensin-converting enzyme inhibitors in the management of congestive heart failure. Am J Cardiol 75:3F-6FCrossRefGoogle Scholar
  6. 6.
    Packer AC, Gheorghiade M, Young J et al (1993) Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. N Engl J Med 329:1–7PubMedCrossRefGoogle Scholar
  7. 7.
    The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators (1993) Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 342:821–828Google Scholar
  8. 8.
    Packer M (1998) Do beta-blockers prolong survival in chronic heart failure? A review of the experimental and clinical evidence. Eur Heart J 19[Suppl B]:B40–46Google Scholar
  9. 9.
    Packer M, Bristow MR, Cohn JN et al (1996) The effect of Carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 334:1349–1355PubMedCrossRefGoogle Scholar
  10. 10.
    Packer M (2001) Effect of Carvedilol on survival in severe chronic heart failure. N Engl J Med 344:1651–1658PubMedCrossRefGoogle Scholar
  11. 11.
    Hochleitner M, Hortnagl H, Ng CK et al (1990) Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy. Am J Cardiol 66:198–202PubMedCrossRefGoogle Scholar
  12. 12.
    Auricchio A, Sommariva L, Salo P et al (1993) Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual chamber pacing with shortened AV delay. Pacing Clin Electrophysiol 16:2034–2043PubMedCrossRefGoogle Scholar
  13. 13.
    Hochleitner M, Hortnagl H et al (1992) Long term efficacy of physiologic dual chamber pacing in the treatment of end stage idiopathic dilated cardiomyopathy. Am J Cardiol 70:1320–1325PubMedCrossRefGoogle Scholar
  14. 14.
    Brecker SJ, Xiao HB, Sparrow J et al (1992) Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet 340:1308–1312PubMedCrossRefGoogle Scholar
  15. 15.
    Kataoka H (1991) Hemodynamic effect of physiological dual chamber pacing in a patient with end-stage dilated cardiomyopathy: a case report. Pacing Clin Electrophysiol 14:1330–1335PubMedCrossRefGoogle Scholar
  16. 16.
    Gold MR, Feliciano Z, Gottlieb SS et al (1995) Dual-chamber pacing with a short atrioventricular delay in congestive heart failure: a randomized study. J Am Coll Cardiol 26:967–973PubMedCrossRefGoogle Scholar
  17. 17.
    Linde C, Gadler F, Edner M et al (1995) Results of atrioventricular synchronous pacing with optimized delay in patients with severe congestive heart failure. Am J Cardiol 75:919–923PubMedCrossRefGoogle Scholar
  18. 18.
    Brecker SJ, Xiao HB et al (1992) Effects of dual chamber pacing with short AV delay in dilated cardiomyopathy. Lancet 70:1320–1325Google Scholar
  19. 19.
    Blanc JJ, Etienne Y et al (1997) Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. Circulation 96:3273–3277PubMedCrossRefGoogle Scholar
  20. 20.
    Cazeau S, Ritter P et al (1994) Four chamber pacing in dilated cardiomyopathy. Pacing Clin Electrophysiol 17:1974–1979PubMedCrossRefGoogle Scholar
  21. 21.
    Auricchio A, Stellbrink C et al (1999) Pacing therapies for congestive heart failure. (PATH-CHF study). Rational, design and endpoints of a prospective, randomized, multicentric study. Am J Cardiol 83:130–135CrossRefGoogle Scholar
  22. 22.
    Saxon L, Boehemer J, Hummel J (1999) Biventricular pacing in patients with CHF: two prospective randomized trials (Vigor CHF). Am J Cardiol 83:120–123DCrossRefGoogle Scholar
  23. 23.
    Saxon L, Kerwin WF, De Marco T et al (1998) The magnitude of sympathoneural activation in advanced heart failure is altered with chronic biventricular pacing. Arch Mal Coeur 91:153Google Scholar
  24. 24.
    Gras D, Mabo P, Tang T et al (1998) Multisite pacing as a supplemental treatment of CHF: preliminary results of the Medtronic InSync study (NASPE abstr). Pacing Clin Electrophysiol 21:2249–2255PubMedCrossRefGoogle Scholar
  25. 25.
    Huth C, Friedl A, Klein H, Auricchio A (2001) Pacing therapies for congestive heart failure considering the results of the PATH-CHF study. Z Kardiol 90[Suppl 1]:10–15PubMedCrossRefGoogle Scholar
  26. 26.
    Cazean S, Leclercq C, Lavergne T et al (2001) Effects of multisite biventricular pacing in patients with heart failure and interventricular conduction delay. N Engl J Med 344:873–880CrossRefGoogle Scholar
  27. 27.
    Padeletti L, Porciani MC, Santini M et al (2001) InSync Italian Registry: long term clinical results of cardiac resynchronization. Europace Suppl 2:B58:787Google Scholar
  28. 28.
    Gulizia M, Ricci R, Lunati M et al (2001) InSync Italian Registry: does biventricular pacing impact on patients hospitalizations? Europace Suppl 2:B59:816Google Scholar
  29. 29.
    Auricchio A, Stellbrink C, Sack S et al (2001) PATH-CHF study: reduced hospitalization days due to heart failure. Europace Suppl 2:B49:471Google Scholar
  30. 30.
    Leclercq C, Cazeau S, Le Breton H et al (1998) Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J Am Coll Cardiol 32:1825–1831PubMedCrossRefGoogle Scholar
  31. 31.
    Kass DA, Chen CH, Curry C et al (1999) Improved ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 30:1567–1573CrossRefGoogle Scholar
  32. 32.
    Auricchio A, Stellbrink C, Block M et al (1999) Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure: the Pacing Therapies for Congestive Heart Failure Study Group: the Guidant Congestive Heart Failure Research Group. Circulation 99:2993–3001PubMedCrossRefGoogle Scholar
  33. 33.
    Alonso C, Leclercq C, Victor F et al (1999) Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. Am J Cardiol 84:1417–1421PubMedCrossRefGoogle Scholar
  34. 34.
    Kadhiresan V, Vogt J, Auricchio A et al (2000) Sensitivity and specificity of QRS duration to predict acute benefit in heart failure patients with cardiac resynchronization. NASPE 2000, part 11:555Google Scholar
  35. 35.
    Nelson G, Curry CW, Wyman BT et al (2000) Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay. Circulation 101:2703–2709PubMedCrossRefGoogle Scholar
  36. 36.
    Butter C, Auricchio A, Stellbrink C et al (2001) Longer LV-RV delay may not yield better BiVRT outcome in HE Europace Suppl 2:B 11:649Google Scholar
  37. 37.
    Yu Y, Auricchio A, Butter C et al (2001) Assess effectiveness of BiVRT using surface QRS duration. Europace [Suppl 2]B11:770Google Scholar
  38. 38.
    Achilli A, Bocchiardo M, Sassara M et al (2001) Biventricular stimulation: comparison of results of sinus rhythm and chronic atrial fibrillation patients. Europace Suppl 2:B11:612Google Scholar
  39. 39.
    Montenero AS, Santini M, Lunati M et al (2001) InSync Italian Registry: baseline predictive factors of the clinical outcome. Europace Suppl 2:B49:613Google Scholar
  40. 40.
    Lunati M et al (2001) NASPE 2001Google Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • M. Gulizia
    • 1
  1. 1.Cardiology, S. Luigi-S. Currò HospitalCataniaItaly

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