14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-116

Rationale for multi-site biventricular pacing to treat refractory heart failure

J. Claude Daubert, Christine Alonso, Philippe Mabo, Christophe Leclerq.
Département de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, Hôpital Pontchaillou - CHU, Rennes, France

Conclusion

By correcting left ventricular asynchrony as well as left atrio-ventricular asynchrony, multisite biventricular pacing appears to significantly and durably improve the functional status, the quality of life and exercise tolerance of patients with drug-refractory heart failure secondary to chronic LV systolic dysfunction, and major intraventricular conduction delay, thus corresponding to 20-30% of class III-IV patients. The technique appears highly promising as an adjuvant treatment of drug-refractory heart failure, in particular in class III patients, as mortality remains high in class IV patients. However, controlled and randomized trials will be necessary to validate this novel concept and better define responding patients. The results of a small German study (PATH-CHF) with use of the epicardial route to pace the left ventricle, are expected soon. The MUSTIC trial is ongoing in Europe, under the auspices of the European Society of Cardiology, with the primary objective to assess the actual impact of biventricular pacing on exercise tolerance and quality of life.

Inclusion was completed on April 1999 and final results are expected in the early 2000. Other prospective multicenter trials were recently started both in Europe and in North America (MERIDIEN, MIRACLE, PATH-CHF II, VIGOR-CHF…). Further and larger studies will be needed after, to assess the effect on morbidity, mortality and cost-effectiveness. Technical advances should be evaluated in parallel, especially the potential interest to combine in the same implantable device multisite pacing and ICD function. The objective should be to significantly decrease the risk of sudden cardiac death which accounts for 30 to 50% of total mortality in class III-IV patients.

So, do we have reasons to be enthusiastic about multisite pacing? Probably yes, but there is still a long way to go before validating definitively this new concept.