Upgrading from single chamber right ventricular to biventricular pacing in permanently paced patients with worsening heart failure: The RD-CHF study

  • Leclercq C
  • Cazeau S
  • Lellouche D
 et al. 
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BACKGROUND: Biventricular (BiV) stimulation lowers morbidity and mortality in patients with drug-refractory congestive heart failure (CHF), depressed left ventricular (LV) function, and ventricular dyssynchrony in absence of indication for permanent cardiac pacing. This pilot, single-blind, randomized, cross-over study examined the safety and efficacy of upgrading conventional pacing systems to BiV stimulation in patients with advanced CHF.

METHODS: We included 56 patients in New York Heart Association (NYHA) functional classes III or IV despite optimal drug treatment and ventricular dyssynchrony (interventriclar delay > 40 ms or LV preejection delay > 140 ms) in need of pacemaker replacement. We compared the patients' functional status, arrhythmias, and standard echocardiographic measurements during 3 months of conventional, single right ventricular (RV) versus 3 months of BiV stimulation.

RESULTS: There were 44 patients in the cross-over phase. QRS duration was shortened by 23% and LV preejection delay by 16% with BiV stimulation. NYHA functional class, 6-minute hall walk and quality of life score were significantly improved with BiV stimulation compared with single RV pacing by 18%, 29%, and 19%, respectively. No significant difference was observed in the ventricular arrhythmia burden or LV reverse remodeling between the 2 periods.

CONCLUSIONS: This pilot study showed that upgrading from RV pacing to BiV pacing significantly improves symptoms and exercise tolerance in chronically paced patients with advanced CHF and mechanical dyssynchrony.

Author-supplied keywords

  • Biventricular stimulation
  • Cardiac pacing
  • Cardiac resynchronization therapy
  • Heart failure
  • Ventricular dyssynchrony

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  • Christophe Leclercq

  • Serge Cazeau

  • David Lellouche

  • Fabien Fossati

  • Fréderic Anselme

  • Jean Marc Davy

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