Is There a Role for Left Ventricular Pacing in the Treatment of Congestive Heart Failure?

Abstract

Relations between cardiac pacing and heart failure have evolved with time. During the early years patients with chronic atrioventricular (AV) block not only had recurrent syncopes but also very often had more or less severe signs of congestive heart failure (CHF) and at that time treatment was limited to right ventricular pacing. These initial encouraging results in treating heart failure due to bradycardia were rapidly obviated by observations of initiation of CHF by VVI pacing, particularly in patients with sinus node disease. Signs of heart failure were integrated in the description of the pacemaker syndrome [1]. Dual-chamber pacing eliminated this side effect and pacing was again considered as a treatment for CHF not only in patients with chronic AV block but also in those with sinus node disease who may develop signs of heart failure when they are not adequately treated. It should be noted that in all these early observations CHF was not an indication for pacing per se but treated through the restoration of a «normal» ventricular rate.