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CLINICAL STUDY: BIVENTRICULAR PACING

Atriobiventricular pacing improves exercise capacity in patients with heart failure and intraventricular conduction delay

Chetan Varma, MD^*, Sanjay Sharma, MD^*, Sam Firoozi, MD^*, William J. McKenna, MD, FACC^*,*, Jean-Claude Daubert, MD, FACC Multisite Stimulation in Cardiomyopathy (MUSTIC) Study Group

^* Department of Cardiological Sciences, St. Georges Hospital Medical School, London, United Kingdom
Département de Cardiologie & Maladies Vasculaires, Centre Cardio-Pneumologique, Hôpital Pontchaillou, Rennes, France

Manuscript received December 31, 2001; revised manuscript received May 21, 2002, accepted October 4, 2002.

^* Reprint requests and correspondence: Dr. William J. McKenna, Department of Cardiological Sciences, St. Georges Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK, United Kingdom.
wmckenna{at}sghms.ac.uk

OBJECTIVES: We sought to assess the efficacy of biventricular pacing with respect to both peak and submaximal measures of exercise in patients with New York Heart Association class III heart failure (HF) and intraventricular conduction delay in a randomized, blinded study.

BACKGROUND: Submaximal and maximal changes in exercise capacity need evaluating in this patient population with this novel therapy.

METHODS: Graded exercise and 6-min walk tests were performed in patients randomized to three months each of active (atrio-biventricular) and inactive pacing. Minute ventilation (VE), oxygen uptake (VO₂), ventilated carbon dioxide (VCO₂) and heart rate were measured in patients achieving a respiratory quotient >1 (n = 30). Oxygen pulse, anaerobic threshold (AT) and ventilatory efficiency (VE/VCO₂) were calculated.

RESULTS: Active biventricular pacing increased peak VO₂ (15.8 ± 4.3 vs. 14.4 ± 4.6 ml/kg/min, p = 0.02), exercise time (501 ± 223 s vs. 437 ± 233 s, p < 0.001) and oxygen pulse (9.3 ± 2.8 vs. 8.1 ± 3.1 ml/beat, p < 0.01) compared with inactive pacing. The submaximal measures of exercise capacity significantly increased with active pacing: AT (11.2 ± 4.1 ml/kg/min vs. 9.5 ± 2.3 ml/kg/min, p = 0.02) and 6-min walk (414 ± 94 m vs. 359 ± 94 m, p = 0.001). Minute ventilation/ventilated carbon dioxide improved (32 ± 9 vs. 36 ± 11, p = 0.03) with normalization of the VE/VCO₂ slope in 59% of patients (chi-square test, p = 0.002) with active pacing.

CONCLUSIONS: Biventricular pacing may improve maximal and submaximal exercise capacity in patients with advanced HF and intraventricular conduction delay.

Abbreviations and Acronyms   AT   anaerobic threshold   CPET   cardiopulmonary exercise test   HF   heart failure   HR   heart rate   LV   left ventricle, ventricular   MUSTIC   Multisite Stimulation in Cardiomyopathy study   NYHA   New York Heart Association   QOL   quality of life   VCO2   ventilated carbon dioxide   VE   minute ventilation   VO2   oxygen uptake

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