Biventricular pacing in patients with ICD: how many patients are possible candidates?

Abstract

BACKGROUND:

About 80 % of patients receiving an implantable cardioverter-defibrillator (ICD) due to life-threatening episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) have structural heart disease. ICD implantation reduces the risk of sudden cardiac death to less than 2 %. However, the major obstacle in these patients is chronic heart failure (CHF). Biventricular stimulation (BIV) has shown its efficiency as an alternative therapy in drug refractory CHF.

METHODS:

According to the InSync registry, we predefined possible indications for BIV as follows: complete branch bundle block (> 120 ms), left-ventricular ejection fraction (EF) < 35 % and NYHA class > II. We evaluated the number of patients presenting this indication at time of implant and during follow-up (FU) at our ICD clinic.

RESULTS:

Between 1992 and 1998, 360 patients were provided with an ICD (mean age 64.6 +/- 5.4 yrs, mean EF 37 +/- 14 % at implant, 82 % of patients with organic heart disease). Mean FU was 34 +/- 21 months. During FU 46 patients (13 %) died, 15 of these (33 %) presenting criteria for BIV. 33 patients died of heart failure, there was 1 sudden death and 12 patients died for non-cardiac reasons. 35 % of the patients who died of heart failure had an indication for BIV.

CONCLUSIONS:

About 10 % of ICD patients had an indication for BIV at time of implant. Over a mean FU period of 34 months, 16% of all patients presented an indication for BIV. Patients with an indication for BIV had a higher mortality rate and more frequent atrial fibrillation compared to patients without. With this data and the good clinical results after BIV-ICD implantation, we consider the implantation of a BIV-ICD system in every patient with appropriate indications.

• Authors: C Werling, U Weisse, G Siemon, A-H Kiessling, M Rameken, H Schwacke, W Saggau, J Senges, K Seidl
• Journal: The Thoracic and cardiovascular surgeon (Thorac Cardiovasc Surg) Vol. 50 Issue 2 Pg. 67-70 (Apr 2002) ISSN: 0171-6425 [Print] Germany
• PMID: 11981703 (Publication Type: Journal Article)

Topics

• Aged
• Arrhythmias, Cardiac (therapy)
• Cardiac Pacing, Artificial (methods)
• Death, Sudden, Cardiac (prevention & control)
• Defibrillators, Implantable
• Female
• Heart Failure (prevention & control, therapy)
• Humans
• Male
• Middle Aged
• Patient Selection
• Retrospective Studies
• Treatment Outcome