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.
Key words
Biventricular pacing - ICP - Indication
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1
MD Christiane Werling
Klinik für Herzchirurgie, Herzzentrum Ludwigshafen
Bremserstrasse 79
67063 Ludwigshafen
Germany
Telefon: +49 (621) 5 03 40 50
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