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long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay

Angelo Auricchio, MD, PhD^*,*, Christoph Stellbrink, MD, Stefan Sack, MD^¶, Michael Block, MD^||, J.ürgen Vogt, MD^**, Patricia Bakker, MD, Christof Huth, MD, Friedrich Schöndube, MD, Ulrich Wolfhard, MD^#, Dirk Böcker, MD^||, Olaf Krahnefeld, MD^**, Hans Kirkels, MD, PhD Pacing Therapies in Congestive Heart Failure (PATH-CHF) Study Group

^* CardiologyMagdeburg, Germany
Cardiac Surgery, University Hospital, Magdeburg, Germany
Cardiology, Magdeburg, Germany
Cardiovascular Surgery, University Hospital RWTH, Aachen, Germany
^|| Department of Cardiology, University Hospital, Münster, Germany
^¶ Cardiology, Münster, Germany
^# Cardiovascular Surgery, University Hospital, Essen, Germany
^** Heart Center, Bad Oeynhausen, Germany
Cardiac Surgery, Essen, Germany
Cardiology, University Hospital, Utrecht, The Netherlands

View larger version (29K): [in a new window]   Figure 1 Flow chart of the Pacing Therapies in Congestive Heart Failure study, which was conducted between August 1995 and October 1998. CRT = cardiac resynchronization therapy; NYHA = New York Heart Association; SCD = sudden cardiac death; VT = ventricular tachycardia.

View larger version (24K): [in a new window]   Figure 2 Comparison of hemodynamic responses to stimulation at different sites and atrioventricular (AV) delays, shown as the mean (±SEM) percent changes from baseline in the 40 patients in whom hemodynamic recording was possible. The top plots represent changes in systolic function and bottom plots represent changes in diastolic function. BV = biventricular stimulation; LV = left univentricular stimulation; LVEDP = left ventricular end-diastolic pressure; max dP/dt = maximum rate of change in left ventricular pressure; min dP/dt = minimum rate of change in left ventricular pressure; RV = right univentricular stimulation. Legend symbols indicate statistical differences between stimulation sites over all AV delays (p < 0.001). LV > RV and BV > RV; LV > BV and RV > BV; BV > LV.