Journal Article

The Bad Oeynhausen Experience

Jürgen Vogt, Barbara Lamp, Bert Hansky, Johannes Heintze, Lothar Faber, Holger Güldner, Reiner Körfer and Dieter Horstkotte

in European Heart Journal Supplements

Published on behalf of European Society of Cardiology

Volume 6, issue suppl_D, pages D122-D127
Published in print August 2004 | ISSN: 1520-765X
Published online August 2004 | e-ISSN: 1554-2815 | DOI: http://dx.doi.org/10.1016/j.ehjsup.2004.05.002
The Bad Oeynhausen Experience

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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 [math]35%, left ventricular enddiastolic diameter [math]60 mm, VO2 peak [math]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.

Keywords: Congestive heart failure; Resynchronisation; Coronary heart disease; Dilated cardiomyopathy; Atrial fibrillation; Outcome; 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

Journal Article.  3032 words.  Illustrated.

Subjects: Cardiovascular Medicine

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