RT-209
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Biventricular pacing: role of ICD
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Fiorenzo Gaita, Mario Bocchiardo, Luigi Padeletti*, Cristina Porciani*, Marco Scaglione, Alessandro Costoli*, Laura Vivalda.
Division of Cardiology, Ospedale Civile of Asti, *Division of Cardiology, Ospedale Careggi, Firenze, Italy
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Abstract
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Biventricular pacing is a promising technique to improve left ventricular
function in patients with congestive heart failure and wide QRS, but despite clinical improvement total mortality
is still high, with a sudden death rate up to 65%. Therefore an implantable cardioverter defibrillator could be
lifesaving in a high percentage of these patients. The first cardioverter defibrillator with biventricular pacing was
implanted in our centre in the august 1998 using an Y adapter to join the 2 ventricular leads; since than, 19
patients (16 male and 3 female, mean age of 63±7 years) received this kind of stimulation. All had congestive
heart failure with an ejection fraction <35%, QRS width ³140 ms and sustained ventricular tachycardia or
fibrillation still inducible or spontaneously recurring despite amiodarone. Ventricular resynchronization led to a
narrowing of QRS from 172±27 ms to 149±19 ms, a decrease of the delay between the onset of right and left
ventricular outflow from 42±23 ms to 20±17 ms, a reduction of the mitral regurgitation area from 7.2±4.1 cm2 to
3.7±0.8 cm2 at 1 month. Functional class improved from 2.74 ± 0.73 to 1.40±0.52 three months after the implant.
Eight patients (42%) had shocks during a follow up of 191±100 days: 4 only appropriate shocks, 2 only inappropriate
shocks, 2 both appropriate and inappropriate shocks. All inappropriate shocks occurred during sinus tachycardia
with spontaneous atrioventricular conduction and didn’t recur with reprogramming of upper rate and
atrioventricular delay. One patient died for severe pump failure 3 days after the implant.
CONCLUSION. Biventricular pacing is feasible also with a cardioverter defibrillator; the problem of double
sensing has been resolved with the new devices that allow sensing programmability from only one ventricle.
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Key Words
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