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    • br Results The effect of BiV pacing and

    2019-05-08


    Results The effect of BiV pacing and LV only pacing on hemodynamic responses is shown in Table 1. According to these results, no statistically significant differences in hemodynamic responses were seen in the two groups. Given that the end diastolic and systolic volume is different in men and women, the results were analyzed by sex. However, no statistically significant differences in the hemodynamic responses were seen between the two groups.
    Discussion The main objective of this study was to compare the hemodynamic responses of BiV pacing with those of LV pacing alone. The benefits of LV pacing include (1) the transition from BiV to LV pacing increases the longevity of the device and decreases the costs of repeated surgery; (2) if the right ventricular (RV) threshold increases or RV lead is displaced, with maintaining an acceptable sensitivity, repeated surgery can be avoided by changing the pacing mode from BiV to LV only pacing; (3) in countries with limited resources where the cost of acquiring a pace and triple-chamber implantable cardioverter defibrillator (CRT) is high, dual-chamber devices can be used on the right atrium and left ventricle position, which is cost efficient. The results indicated that the benefits of the two procedures are similar. According to the European Society of Cardiology (ESC) guidelines on cardiac pacing and CRT, LV pacing alone may be considered as an alternative mode for BiV pacing. Furthermore, a respective 21% of patients who did not respond clinically or echocardiographically to BiV pacing responded to LV pacing mode [9]. Moreover, a recently conducted meta-analysis has demonstrated that in patients with moderate-to-severe nfps failure, these two pacing modalities did not differ with regard to death/heart transplantation or need for hospitalizations [16]. In 2011, Thibault et al. conducted a multicenter, double-blind, crossover trial and compared the effects of LV and BiV pacing on exercise tolerance and LV remodeling in 211 patients with an LV ejection fraction ≤35%, QRS≥120ms, and symptoms of heart failure. They concluded that LV pacing was not superior to BiV pacing. Moreover, non-responders to BiV pacing may respond favorably to LV pacing [17]. The LV mode may have number advantages. First, in patients with severe heart failure who need three-chamber CRT, based on the guideline, using the LV mode may reduce the cost. Second, the time of implanting the LV mode is less than that of the BiV mode. Thus, using the first approach can reduce the harmful exposure to radiation in both the patient and physician. Third, in cases where the right ventricular lead placement is difficult or even impossible for any reason, the LV mode can be considered as an alternative approach.
    Conclusion Understanding the mechanism responsible for the lack of difference between LV and BiV pacing was not an objective of this study. As desynchronizing mostly affects the left ventricle [18–22], using LV pacing alone may be similar to BiV pacing. We conclude that LV pacing alone is not inferior to BiV pacing, and the hemodynamic response was similar in the two groups. However, more evidence, based on large clinical trials, is warranted in order to confirm our results.
    Funding This study was funded by the Vic-chancellor of Research and Technology, Hamadan University of Medical Sciences.
    Conflict of interest
    Acknowledgments
    Introduction Previous studies showed that cardiac resynchronization therapy (CRT) improves quality of life and functional status; reduces hospitalizations for heart failure; and prolongs survival in patients with severe heart failure, low left ventricular (LV) ejection fraction (LVEF), and LV dyssynchrony [1,2]. Although the beneficial effect of CRT has been demonstrated, 20–30% of patients still do not receive the full clinical benefit of CRT [3]. It is necessary to correct electrical and mechanical dyssynchrony through an optimally timed stimulation of the right ventricle (RV) and LV. Although echocardiographic evaluation is used most frequently when performing device optimization [4], the accuracy of echocardiography is affected by measurement errors [5].