Stymulacja dwupunktowa prawej komory jako alternatywna metoda leczenia pacjentów z asynchronią lewokomorową po nieudanej implantacji elektrody lewokomorowej układu resynchronizującego Bifocal right ventricular pacing as an alternative treatment for patients with ventricular asynchrony and unsuccessful left ventricular implantation of cardiac resynchronization system

Background: Biventricular pacing has demonstrated benefit for patients with congestive heart failure although in 5-15% unsuccessful left ventricular lead implantation is reported. Alternative for failed transvenous left ventricular implantation is epicardiac approach with thoracotomy. Unfortunately this method is associated with very serious complications. Additionally this method increases the costs of the procedures and is available in cardiosurgery units only. It is reported that bifocal pacing in right ventricle might be alternative for unsuccessful left ven- tricular lead (LVlead) implantation. The aim of the study was clinical and hemodynamic assessment, during 3 month follow up (3mFU) of patients in which bifocal pacing (BiF) in right ventricle was used, for a standard transvenous BiV procedures proved to be ineffective or unsatisfactory. Material and methods: The eight patients with mean age 65 ± 9, in NYHA IV, with LVEF = = 22%, mean QRS duration = 180 ms with failed LVlead implantation were included to the study. In all patients leads in right atrium appendage and to the apex and outflow tract of the right ventricle were implanted and connected to the Stratos LV pacemaker (PM) Results: In patients after BiF implantation significant increase in 6 minute walking test was reported. There was no significant difference in QRS duration after procedure. Significant reduction in intraventricular mechanical delay, left ventricular systolic diameter and increase in EF, cardiac output and cardiac index in patients with BiF in ECHO study was assessed.