Heart failure (HF) is a lethal disease process that involves progressive ventricular remodeling and symptom worsening. Two strategies applied to HF populations include biventricular re-synchronization pacing (BiVP) and left ventricular assist as destination therapy (DT). While there may be some overlap in these populations the therapies are generally thought of separately. Among the benefits of BiVP are ventricular resynchronization and improved oxygen consumption. Little information is known about the impact of DT on cardiac desynchronization and its impact on ventricular electromechanical recovery.
We analyzed the ECG intervals of 16 patients who received DT with a Heartmate XVE (Thoratec) secondary to end stage HF. Patients whose baseline ECG was paced (7) were excluded from analysis. The remaining 9 patients (8 men) were aged 50-79 (mean 64.8) years. The patients were supported from 1-180 days at the time of analysis.
The mean patients were supported from 1-180 days at the time of analysis. Heart baseline and follow-up intervals are shown in the table below.
While none of the intervals changed significantly during DT support, there was a trend towards improvement in QRS duration; of patients supported, the average improvement in QRSD was 15.4 msec (10.5%) whereas for patients supported > 20 days the improvement was 37.5 msec (21%). The only 2 patients to improve QTc were those supported 180 days. On the other hand PR did not improve in any patient.
In summary, DT allows for long-term ventricular support and recovery. Improvement in cardiac desynchronization without BiVP may also occur after ventricular support. Longer observation needs to be applied to this phenomenon and to consider the potential for LVAD support to restore normal ventricular resynchronization.
IntervalBaselineFollow-UpPR (msec)173.8185.2QRS (msec)146.2130.8QTc (msec)460.6463.7
Smitha Agadi, None.