Biventricular Pacing with ICD Backup: A Luxury or a Necessity?

Abstract

The prevalence of heart failure (HF) in Europe has recently been estimated to be on the order of 6.5 million individuals [1]. HF is the only major cardiovascular disease that is increasing in incidence [2] with approximately 580 000 new cases diagnosed each year. The treatment of HF includes oral administration of (3-blockers, ACE inhibitors/AT II receptor antagonists, diuretics, spironolactone, and digitalis. Nitrates and intravenously administered inotropes can be added for acute periods of hemodynamic decompensation. Nonetheless, many patients remain severely symptomatic despite optimal medical therapy. Cardiac resynchronisation therapy (CRT), also called biventricular pacing, can profit somewhere between 10% and 30% of patients with HF [3, 4]. The indications for CRT are the coexistence of symptomatic HF, including left ventricular dysfunction, and a wide QRS complex, such as is demonstrated by left bundle branch block (LBBB). There is a fast growing body of evidence suggesting that CRT may be a beneficial adjunct in the treatment array for chronic HF. In respect of short-and medium-term hemodynamic and efficacy parameters, patients in the PATH-CHF [5] and the MIRACLE [4] randomized controlled trials have demonstrated significant improvement in both maximal and submaximal exercise as well as in quality of life. The short-term beneficial effect of CRT is also maintained in the long term for patients in NYHA classes II, III, and IV [6,7].