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The European Society of Cardiology

The Bad Oeynhausen Experience

Jürgen Vogta,*,1, Barbara Lampa,1, Bert Hanskyb,1, Johannes Heintzea, Lothar Fabera, Holger Güldnerb, Reiner Körfera and Dieter Horstkottea

a Department of Cardiology, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
b Department of Thoracic and Cardiovascular Surgery, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany

Received 3 May 2004; accepted 24 May 2004.

* Jürgen Vogt, MD, Department of Cardiology, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany. Tel.: +49-5731-971258; fax: 49-5731-972194
akohlstaedt{at}hdz-nrw.de

Abstract

Introduction Patients with advanced heart failure received cardiac resynchronisation therapy at our centre, if the following selection criteria were fulfilled: NYHA class >=3, left bundle branch block with QRS width >=150 ms, left ventricular ejection fraction 35%, left ventricular enddiastolic diameter 60 mm, VO2 peak 18 ml/min/kg. Patients with atrial fibrillation and left bundle branch block were also included. Patients with a preoperative pulse pressure increase of >=10% under left/biventricular stimulation were regarded "responders" and had permanent implantation of a resynchronisation device.

Patients and results 313 patients (79 women, mean age 62±10 years, 110 patients with coronary heart disease, 174 patients with dilated cardiomyopathy and 28 patients after valve replacement or with end-stage hypertrophic cardiomyopathy) underwent resynchronisation. Mean VO2 peak was 13.0±2.8 ml/min/kg, ejection fraction 23.5±7.2% with a mean left ventricular enddiastolic diameter of 79.5±10.6 mm. 32 of 251 had progressive pump failure, which was more frequent in patients with CHD and AF. 21 of 204 patients (20%) with CHD compared to 22 of 179 patients (13%) with DCM had pump failure progression after 30-month follow-up.

Conclusion The tailored implantation of the left ventricular lead and programming of the optimal pacing mode resulted in a VO2 peak increase by 2.8 ml/min/kg during follow-up. During mid-term follow-up of 18 months, DCM patients demonstrated a higher clinical benefit than patients with CHD. In the future, areas and extent of mechanical and electrical asynchrony have to be evaluated more exactly by tissue Doppler echocardiography.

Key Words: Congestive heart failure • Resynchronisation • Coronary heart disease • Dilated cardiomyopathy • Atrial fibrillation • Outcome

List of Abbreviations: AF atrial fibrillation • CHD coronary heart disease • DCM dilated cardiomyopathy • EF ejection fraction • HTX heart transplantation • LVAD left ventricular assist device • LVEDD left ventricular enddiastolic diameter • QOL quality of life (Minnesota score) • SR sinus rhythm • VO2AT oxygen consumption at anaerobic threshold • VO2peak oxygen consumption at peak exercise


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