CLINICAL STUDY
Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy
Steven L. Higgins, MD, FACC*,
Patrick Yong, MSEE ,
Donald Scheck, BSEE,
Martin McDaniel, BA,
Florence Bollinger, RN*,
Mona Vadecha, BA*,
Shoma Desai, BA*,
David B. Meyer, MD, FACC* for the Ventak CHF Investigators
* Electrophysiology Service, Scripps Memorial Hospitals, La Jolla, California, USA
Guidant Corporation, St. Paul, Minnesota, USA
Manuscript received October 25, 1999;
revised manuscript received March 15, 2000,
accepted April 26, 2000.
Reprint requests and correspondence: Dr. Steven L. Higgins, Arrhythmia Service, Scripps, Memorial Hospital, 9850 Genessee Avenue #940, La Jolla, California 92037
EPdocHiggins{at}msn.com
OBJECTIVES
We sought to test the postulate that biventricular pacing diminishes the need for appropriate tachycardia therapy. We reviewed the frequency of therapy in patients, serving as their own controls, who were enrolled in the Ventak CHF (congestive heart failure) biventricular pacing study.
BACKGROUND
It is well established that both acute and chronic CHF contribute to the need for tachyarrhythmia therapy in recipients of an automatic implantable cardioverter defibrillator (ICD). Synchronized biventricular (BV) pacing is a new and promising therapy for symptomatic improvement of CHF in selected patients (low ejection fraction, intraventricular conduction delay). We postulate that this pacing therapy will diminish the need for tachyarrhythmia therapy.
METHODS
Participants in the Ventak CHF trial received a triple-chamber biventricular ICD with a transvenous right ventricular lead and a left ventricular (LV) lead placed via thoracotomy. Of 54 patients enrolled in the Ventak CHF trial, 32 could be analyzed, with each completing three blinded months programmed to BV VDD pacing and a second randomly assigned three-month period of no pacing.
RESULTS
Of the 32 patients, 13 (41%) received appropriate therapy for a ventricular tachyarrhythmia at least once in the six-month monitoring period postimplant. Five patients (16%) had at least one tachyarrhythmic episode while programmed to BV pacing, whereas 11 (34%) had at least one episode while programmed to no pacing. Three patients (9%) received therapy in both pacing periods, two with BV pacing only. The decrease in necessary tachycardia therapy during the BV pacing period was statistically significant (p = 0.035).
CONCLUSIONS
In patients with standard ICD indications who also have CHF, LV dysfunction, and an intraventricular conduction delay, ICD therapy is less common with BV pacing. The mechanism for this improvement is unclear but may be related to hemodynamic improvement in CHF. Although BV pacing does not obviate the need for an ICD, it does diminish the need for appropriate tachyarrhythmia therapy in selected patients.
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Abbreviations and Acronyms
| | ATP | = antitachycardia pacing | | BV | = biventricular | | HF | = heart failure | | ICD | = implantable cardioverter defibrillator | | LV | = left ventricular | | NYHA | = New York Heart Association | | VT | = ventricular tachycardia |
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