WESTPORT, CT (Reuters Health) – In patients with heart failure who require biventricular pacing (BVP), endocardial left ventricular stimulation leads to better cardiac resynchronization, LV filling and systolic performance than epicardial LV pacing, a French team of cardiologists has found.
Dr. Stephane Garrigue and colleagues from the University of Bordeaux in Pessac studied 23 patients with severe heart failure and wide QRS who received a pacemaker for BVP. Fifteen patents underwent epicardial LV pacing via the coronary sinus and eight underwent endocardial LV pacing via the transeptal approach due to an unsuitable coronary sinus. All patients underwent echocardiography and Doppler imaging 6 months after pacemaker implantation.
In the October 15th issue of The American Journal of Cardiology, the team reports that all patients improved clinically with multisite ventricular pacing. However, standard echocardiographic and Doppler tissue parameters showed greater improvement with endocardial pacing compared with epicardial pacing.
For example, a "more marked QRS narrowing" was observed in the endocardial BVP group than in the epicardial BVP group. Endocardial BVP also resulted in significantly greater hemodynamic improvement and provided a "more homogenous systole, leading to longer LV filling time," the authors say.
In comments to Reuters Health, Dr. Garrigue said that "the concept is clear: endocardial left ventricular pacing provides higher hemodynamic performances than epicardial LV pacing (via the coronary sinus). In addition, the transeptal approach allows you to choose the LV pacing site independently of the anatomy of the coronary sinus."
Am J Cardiol 2001;88:858-862.
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