Abstract
Background: Permanent pacing for the treatment of heart failure (HF) has been the subject of intense research over the past decade. Those with conduction abnormalities may benefit most from pacing. The incidence of these conduction abnormalities in patients referred for cardiac transplantation and its relationship to outcome has not been well described.
Hypothesis: This study sought to determine the incidence of these abnormalities and to correlate these findings to outcome in this patient population.
Methods: A review of 100 patients referred for transplantation was performed. Data were analyzed in two groups: those with QRS duration < 120 ms and those with a QRS duration > 120 ms. Times to transplantation or death were analyzed in these two groups.
Results: Of these patients, 34% had QRS duration ≥ 120 ms and survival was inversely associated with QRS duration. Of those with QRS duration < 120 ms, 24% (16) went on to cardiac transplantation or died. Of those with a QRS duration ≥ 120 ms, 55% (17) went on to transplantation or died (p = 0.0134).
Conclusions: This suggests that in addition to a multi‐drug regimen for heart failure, 34% of patients referred for transplantation may benefit from additional therapy with biventricular pacing.
Keywords: heart failure, pacing, bundle‐branch block, incidence
Full Text
The Full Text of this article is available as a PDF (28.5 KB).
References
- 1. Konstam MA, Dracup K, Baker D: Heart failure: Evaluation and care of patients with left ventricular systolic dysfunction. Clinical Practice Guidelines: 1994. ‐ Agency for Health Care Policy and Research, U. S. Dept of Health and Human Services, Rockville, Md.
- 2. Foster AH, Gold MR, McLaughlin JS: Acute hemodynamic effects of atriobiventricular pacing in humans. Ann Thorac Surg 1995; 59 (2): 294–300 [DOI] [PubMed] [Google Scholar]
- 3. Cazeau S, Leclerq C, Lavergne T: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001; 344: 873–880 [DOI] [PubMed] [Google Scholar]
- 4. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002; 346: 1845–1853 [DOI] [PubMed] [Google Scholar]
- 5. Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, Campana C, Perini G, Deorsola A, Masotti G, Tavazzi L, Maggioni AP: Left bundle‐branch block is associated with increased 1‐year sudden and total mortality rate in 5,517 outpatients with congestive heart failure: A report from the Italian network on congestive heart failure. Am Heart J 2002; 143: 398–405 [DOI] [PubMed] [Google Scholar]
- 6. Hesse B, Diaz LA, Snader CE, Blackstone EH, Lauer MS: Complete bundle‐branch block as an independent predictor of all‐cause mortality: Report of 7,073 patients referred for nuclear exercise testing. Am J Med 2001; 110: 253–259 [DOI] [PubMed] [Google Scholar]
- 7. Grigioni F, Carinci V, Boriani G, Bracchetti G, Potena L, Magnani G, Bacchi‐Reggiani L, Magelli C, Branzi A: Accelerated QRS widening as an independent predictor of cardiac death or of the need for heart transplantation in patients with congestive heart failure. J Heart Lung Transplant 2002; 21: 899–902 [DOI] [PubMed] [Google Scholar]