RESUMO
To prevent deterioration of left ventricular function during right ventricular apical pacing, permanent direct His bundle stimulation can be considered in selected patients with low left ventricular ejection fraction and a normal His-ventricle conduction time. We describe our first short-term experiences with permanent direct His bundle pacing in three patients. In two patients His bundle stimulation was still effective at six weeks' follow-up. In one patient loss of capture was registered, after which conventional RV apical pacing was performed.
RESUMO
OBJECTIVE: To evaluate the use of left ventricular assist devices (LVAD) as bridge to heart transplantation (HTx) in patients with end-stage heart failure. METHOD: Between March 1993 and December 2001, 38 patients with refractory end-stage heart failure underwent HeartMate LVAD (Thoratec, Pleasanton Calif.) implantation. RESULTS: A total of 33 of the 38 patients (87%) survived the implantation and perioperative period. There were five perioperative deaths (13%), two due to right ventricular failure, two as a result of bleeding and one probably due to septic shock at the time of LVAD implantation. Three patients (9%) died late in the postoperative period due to septic shock, mechanical failure of the device and a cerebral embolus resulting from LVAD endocarditis, initiated by an acute cholecystitis. Twelve patients (32%) had one or more infectious episodes during long-term assist, of which one patient died. Four patients are still on the device, waiting for a heart transplantation. Twenty-six patients (76%) underwent HTx after 206±129 days of support. CONCLUSION: These results show the efficacy of LVAD support as a bridge to heart transplantation in patients with end-stage heart failure. Major long-term complications are infections and mechanical failure of the device.
