Isolated left ventricular pacing results in worse long-term clinical outcome when compared with biventricular pacing: a single-centre randomized study

The objective of this study was to compare long-term clinical effects of biventricular pacing with isolated left ventricular pacing. Forty consecutive patients with idiopathic dilated cardiomyopathy and indication for cardiac resynchronization therapy were randomized to biventricular or isolated left ventricular pacing. Clinical and echocardiographic parameters were studied regularly prior to implantation and during 1 year of follow-up. Patients with atrial fibrillation were excluded from the study. A retrospective cross-sectional outcome analysis was performed 4 years after the beginning of the study. Biventricular pacing was associated with more pronounced clinical and echocardiographic benefit compared with left ventricular pacing. Biventricular pacing was associated with significantly more distinct reverse remodelling. Left ventricular ejection fraction improved by 12.5 per cent-points (95% CI 7.3-17.7) compared with 5.1 per cent-points (95% CI 1.1-9.2) (P = 0.01) and left ventricular end-diastolic diameter decreased by 8.69 mm (95% CI 5.2-12.2) compared with 5.1 mm (95% CI 1.5-8.7) (P = 0.05) in the biventricular and left-ventricular pacing group, respectively. Semi-quantitative summarization of response points revealed a greater benefit in the biventricular vs. left ventricular pacing group [mean sum of response points 3.25 (95% CI 2.62-3.88) vs. 2.35 (95% CI 1.74-2.96), respectively, P = 0.06]. After 3 years of follow-up, there was no cardiovascular death in the biventricular pacing group compared with three cardiovascular deaths in the left ventricular pacing group. In patients with idiopathic dilated cardiomyopathy, biventricular pacing is associated with significantly more pronounced benefit in clinical outcomes and reverse remodelling. A retrospective analysis after 3 years of follow-up suggests that isolated left ventricular pacing may be associated with a higher mortality rate compared with biventricular pacing.