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Multisite Stimulation in Patients with
Severe Ventricular Disfunction
Zayas, Roberto; Dorticós, Francisco;
Peix, Amalia; Quiñones, Miguel A;
Castro, Jesús; Dorantes, Margarita;
Arbaiza, Jorge L; Fayat, Yanela;
Instituto de Cardiología y Cirugía Cardiovascular, Ciudad de la Habana, Cuba
Introduction: The resynchronisation
of the heart with the multisite stimulation can produce improvement of the ventricular
function, in patients with dilated Miocardiopathy, severe ventricular dysfunction
and intraventricular conduction troubles.
The results in the first 6 cases are showed in this study.
Objective: Evaluate the results of multisite stimulation.
Material and Method: Two stimulation techniques were applied in 6 patients with refractory heart failure (RHF) functional capacity III-IV (NYHA) and left bundle branch block.
Biventricular stimulation (3 cases): An endocardial electrode (anode) in apex of right ventricle and cathode in coronary sinus or left epicardial site (toracotomy), to stimulate left ventricle(LV).
Bifocal stimulation (3 cases): Cathode in right
outflow tract (ROT) and anode in RV.
In both groups cathode and anode were connected to the ventricular channel of a pacemaker programmed DDD.
A tecnecio ventriculography was made previously, a week and 6 month later, to measure the left ventricular ejection fraction(LVEF), the right one (RVEF), the ventricle synchronization (Tp-p) and the mitral regurgitation index (MRI), with differents AV intervals at the pacemaker.
Results: An improvement
of the functional capacity from III-IV to I-II was observed. The ventricle activity
was resynchronizated. The increase of the LVEF and the reduction of the MRI
were more obvious with the biventricular stimulation. The RVEF was highest with
the bifocal stimulation.
After 6 month following: A dead and a patient with repetitive HF (bifocal stimulation).
Discussion: The Tp-p and the MRI seems to be related to the improve of the LVEF. The increase of the RVEF could initiate a new researching and therapeutic field. Multiple factors can to influence the torpid following of the cases with bifocal stimulation in this study.
Conclusions: The multisite (biventricular) stimulation was an effective alternative. The number of cases should be increased.
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2nd Virtual Congress of Cardiology
Dr. Florencio Garófalo
Dr. Raúl Bretal
Dr. Armando Pacher
Technical Committee - CETIFAC
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