Description

Biventricular pacing is a rapidly developing technique that offers hope for a significant sub-group of patients with severe heart failure refractory to medical treatment and intraventricular conduction delay (LBBB). This technique is thought to improve cardiac function by reducing intraventricular
dysynchrony caused by intra-ventricular conduction block. Technology is now available for low-risk implantation of atrio-biventricular pacing systems with a high level of success in appropriately experienced hands. The short-term haemodynamic effects of such pacing are favourable and published randomised clinical trials have shown benefit with improvement in symptoms and objective measures of exercise capacity. Many questions still remain to be answered. Appropriate selection of patients who will respond to this treatment, the localisation of ideal left ventricular pacing sites, and the development of techniques for optimisation of atrioventricular and interventricular pacing delays are current areas under investigation. Most
importantly, the effect of biventricular pacing on overall mortality is unknown. Longer-term mortality studies are underway to investigate whether multi-site pacing alters the natural history of heart failure. Furthermore, combination devices that provide atrio-BV pacing and an ICD facility
are available. These devices promise to prevent heart failure progression as well as sudden cardiac death through ventricular arrhythmia. The results of these studies may have profound implications on the management of heart failure in the future.