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

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.

Bibliographic Details

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:	Digital revista
Language:	English
Published:	Sociedade Brasileira de Cardiologia - SBC 1999
Online Access:	http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X1999001200003
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