Rai K, Maneesh and Prabhu, Mukund A and Kamath, Padmanabh K and Pai, Narasimha D and Kamath, Ramanath L (2017) ‘Optimized’ LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT. Indian Pacing and Electrophysiology Journal, 17 (3). pp. 72-77. ISSN 09726292

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Abstract

Background: Cardiac Resynchronization therapy (CRT) remains largely under-used in developing countries owing to the high cost of therapy. In this pilot study, we explore ‘optimized’ Left Ventricle Only Pacing (LVOP) as a cost effective alternative to cardiac resynchronization therapy in selected patients with heart failure. Hypothesis: In economically poorer patients with heart failure, left bundle branch block (LBBB) and intact AV node conduction, synchronization can be obtained using a dual chamber pacemaker (leads in right atrium and Left ventricle) with the help of 2D strain imaging. Methods and results: 4 patients underwent LVOP for symptomatic heart failure. Post procedure ‘optimization’ was done using 12 lead electrocardiography and 2D- Strain imaging. Difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff TPL-AC) was calculated for each segment at different AV delays and the AV delay with the smallest Diff TPL-AC was programmed. The mean AV delay that resulted in electrical and mechanical synchrony was 150 ms. After a mean follow up of 6 months, all patients had improved by at least 1 NYHA class. The mean reduction in QRS duration post procedure was �54.5 ± 22.82 ms and the mean improvement in EF was 7 ± 2.75%. Conclusion: Optimized LVOP using 2D strain and ECG can be a cost-effective alternative to CRT in patients with LBBB, heart failure and normal AV node conduction.

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