Effectiveness of Left Ventricular Only Pacing for Heart Failure Patients with Sinus Rhythm and Intrinsic Atrioventricular Conduction

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Introduction: We compared the effectiveness of left ventricular (LV) only pacing with standard biventricular (BiV) pacing by a novel electrogram-based algorithm for atrioventricular (AV) optimization (SMART-AV®, Boston scientific, Minnesota). Methods: 20 patients with NYHA class ≥2 heart failure, LV ejection fraction (LVEF) ≤35% and QRS duration ≥120 ms were implanted with Cognis® (Boston scientific, Minnesota) for CRT and divided into two groups as follows: LV group (13 patients) with LV only pacing and BiV group (7 patients) with standard BiV pacing by SMART-AV® algorithm. LV volumes and systolic function were assessed with echocardiography at baseline and 6 months. A reduction in LV end systolic volume (LVESV) ≥15% was defined as responder. Results: There were no significant differences in baseline characteristics between LV group and BiV group. Although LVESV was significantly decreased in both groups 6 months after pacing, LVEF was improved only in LV group. Responder was higher in LV group than BiV group but there was no statistical significance (76.9% vs 41.9%, P=0.15). There were also no significant differences in reduction of LVESV and change in LVEF. Conclusion: Left ventricular only pacing for patients with intrinsic AV conduction by SMART-AV® algorithm is effective as well as standard BiV pacing.