Policlínico Universitario Héroes del Moncada, Instituto de Cardiología y Cirugía Cardiovascular (ICCC), La habana , Ciudad Habana, Argentina
The ventricular resynchronization has been converted in one of the best therapeutics options for patients with refractory heart failure and mechanical asynchrony. This article shows the outcome in 60 patients with severe ventricular dysfunction and advanced functional class (III-IV) at the Instituto de Cardiología in Havana City.
Evaluate the cardiac resynchronization therapy (CRT) effects over the functional class (FC), exercise tolerance, hospitalizations and survival.
Material and methods:
48 biventricular pacemakers and 12 biventricular defibrillators (bICDs) were implanted in 60 patients with severe heart failure, left ventricular ejection fraction (LVEF) = 35% and mechanical asynchrony, between March 1999 and November 2006. Hospitalizations, walking test, FC, LVEF, mitral regurgitation (MR) and cardiac dimensions were evaluated. Inter and intraventricular asynchronies were also measured.
FC improved from III-IV to I-II. Hospitalizations were reduced 59.7%, the walking test distance increased (p< 0.0001) and significant improvement of the LVEF from 22.3 ± 5.7 to 31 ± 8% were obtained post-implantation. MR decreased from 10.6 ± 5.2 to 5 ± 4.6 cm2. Inter and intraventricular asynchrony improved and positives effects over left ventricular remodelled were found the first year of following. bICD rescued 3 patients with malignant ventricular arrhythmias. The survival was: first year 83.3%, third year 78%, fifth year 50%.
The non response in 3 patients (5%) was related to left ventricular stimulation far from greatest mechanical retard sites. Devices programming (PP and VV interval) aided to enhance the synchrony.
Conclusions: The CRT improved the FC, exercise tolerance and reduced hospitalizations with good survival.