Right ventricular bifocal stimulation in the treatment of dilated cardiomyopathy with heart failure

• Published in: Arquivos brasileiros de cardiologia Vol. 73; no. 6; pp. 492 - 498
• Main Authors: Pachón Mateos, José Carlos, Albornoz, Remy Nelson, Pachón Mateos, Enrique Indalécio, Gimenez, Vera Márcia, Pachón Mateos, Juán Carlos, Pachón, Maria Zélia Cunha, Santos Fº, Eusebio Ramos dos, Medeiros, Paulo de Tarso Jorge, Silva, Marco Aurélio Dias da, Paulista, Paulo Paredes, Sousa, José Eduardo Moraes Rêgo, Jatene, Adib Domingos
• Format: Journal Article
• Language: English; Portuguese
• Published: Sociedade Brasileira de Cardiologia - SBC 01.12.1999; Sociedade Brasileira de Cardiologia (SBC)
• Subjects: CARDIAC & CARDIOVASCULAR SYSTEMS; multisite stimulation and heart failure; pacemaker; multisite stimulation and heart failure; pacemaker
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.1590/S0066-782X1999001200003

OBJECTIVE: To describe a new more efficient method of endocardial cardiac stimulation, which produces a narrower QRS without using the coronary sinus or cardiac veins. METHODS: We studied 5 patients with severe dilated cardiomyopathy, chronic atrial fibrillation and AV block, who underwent definitive endocardial pacemaker implantation, with 2 leads, in the RV, one in the apex and the other in the interventricular septum (sub pulmonary), connected, respectively, to ventricular and atrial bicameral pacemaker outputs. Using Doppler echocardiography, we compared, in the same patient, conventional (VVI), high septal ("AAI") and bifocal ("DDT" with AV interval ~ 0) stimulation. RESULTS: The RV bifocal stimulation had the best results with an increase in ejection fraction and cardiac output and reduction in QRS duration, mitral regurgitation and in the left atrium area (p <= 0.01). The conventional method of stimulation showed the worst result. CONCLUSION: These results suggest that, when left ventricular stimulation is not possible, right ventricular bifocal stimulation should be used in patients with severe cardiomyopathy where a pacemaker is indicated.