How many people with heart failure are appropriate for biventricular resynchronization?

Abstract

Aims: Increasing evidence exists suggesting that biventricular pacing improves outcome and symptoms in severe heart failure if various selection criteria are fulfilled. It is unsure how many people might benefit from this therapy. Our aim was to provide such data.

Methods and results: Over one calendar year all patients admitted to a large U.K. District General Hospital, that were classified with a diagnosis of heart failure, were audited. The selection criteria were; (1) severe heart failure (NYHA class III or IV), (2) heart failure due to a dilated cardiomyopathy, (3) QRS duration greater than 120 ms or (4) the presence of a bundle branch block pattern. Subjects were divided into those in sinus rhythm to determine those who would be suitable for atrially synchronized biventricular pacing and those with an abnormally long PR interval (>210 ms) who might additionally benefit from improved atrioventricular synchrony. 1042 patients were coded with heart failure. 721 fulfilled diagnostic criteria and were studied. 202 (28%) had severe heart failure, 178 (25%) had a QRS of at least 120 ms, 437 (61%) had an ischaemic cardiomyopathy, 176 (24%) an idiopathic cardiomyopathy and 433 (60%) were in sinus rhythm. Overall mortality at the time of census was 29%. 43 patients were suitable for biventricular pacing with a further 29 atrial patients fibrillation who might benefit from biventricular pacing alone.

Conclusion: Using our criteria, approximately 10% of an unselected group of heart failure admitted to a typical U.K. district general hospital over a calendar year would be appropriate for biventricular pacing. This represents a large number of patients who might derive benefit from this new therapy.