An Usefulness of Bi-Ventricular Pacing Study for Heart Failure Patients with Mitral Regurgitation before Cardiac Resynchronization Therapy

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Background: The patients of heart failure with severe mitral regurgitation (MR) were poor prognosis. The cardiac resynchronization therapy (CRT) was improved functional MR in heart failure patients. Objective: The aim of this study was to confirm the clinical usefulness of electrophysiological studies before CRT. Subject and Methods: Twenty-five heart failure patients received a CRT device implantation. Subjects were divided into the 3 groups by severity of MR before CRT; Group I (N=7, none or mild MR), Group II (N=10, moderate MR), Group III (N=8, severe MR). Before CRT, all subjects were examined for acute hemodynamic effects of bi-ventricular pacing using an external pacemaker. We examined the cardiac function using echocardiography before and at 3 months after CRT. Results: The patients who decreased the pulmonary capillary wedge pressure (PCWP) during bi-ventricular pacing were 4 patients of group I, 6 patients of group II and 8 patients of group III. After CRT, the patients who decreased the PCWP and improved MR were observed in 1 of 4 patient in Group I (25%), 4 of 6 patients in group II (67%) and 5 of 8 patients in group III (63%). Conclusion: About 60% of heart failure patients who decreased the PCWP during bi-ventricular pacing were improved MR after CRT.