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

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

RT-210

New concepts of dual-chamber or biventricular pacing therapy in patients with life-threatening ventricular tachyarrhythmias

Hans-Joachim Trappe, Michael Achtelik, Petra Pfitzner, Bernward Voigt, Peter Weismüller.
Department of Cardiology and Angiology, Ruhr-University, Bochum, Germany

Abstract

BACKGROUND. It seems that 10-20% of patients (pts) who undergo cardioverter-defibrillator (ICD) implantation require concomitant single- or dual-chamber pacing (DDD) for sinoatrial or atrioventricular conduction disturbances. Improvement of left ventricular function is one of the most important issues to decrease cardiac mortality in ICD pts.

METHODS. We studied 32 pts who underwent either DDD (27 pts) or biventricular (BV) ICD implantation (5 pts). In all pts, intraoperative electrophysiologic characteristics and long-term follow-ups were studied. 269 pts with single lead ICDs served as controls.

RESULTS. Implantation of DDD- or BV-ICDs was possible in all pts without any problems. The mean time for ICD implantation was 57±21 min (range 40 to 135 min) and was significantly longer compared to single lead ICD implantation (269 pts) (mean time 37±21 min [range 25 to 105 min]) (p<0.05). The mean time for BV-ICD implantation was 228±45 min (range 163 to 284 min) and was significantly longer compared to single lead ICD implantation (mean time 41±25 min, range 25 to 96 min) (p<0.01). During the mean follow-up of 18 months, no patient died; in pts with DDD-ICDs, functional class of heart failure improved in 8 patients (30%) and remained unchanged in 19 patients (70%) (p=ns). In pts with BV-ICDs hemodynamic improvements were observed in all. The QRS complex shortened significantly during BV with a mean QRS width of 140±14 msec (range 110 to 180 msec) compared to a mean baseline QRS-duration of 170±32 msec (range 128 to 210 msec) (p<0.05).

CONCLUSION. The introduction of DDD-ICDs has led to more sophisticated patient management. ICDs with BV are very promising devices to improve cardiac output, functional class of heart failure and may be decrease long-term mortality significantly. These new ICD developments may offer new hope for some patients with severe end-stage heart failure and life-threatening ventricular tachyarrhythmias.

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