Relief of Drug Refractory Angina by Biventricular Pacing in Heart Failure


Address for reprints: Maurizio Gasparini, M.D., Istituto Clinico Humanitas Via Manzoni, 56–20089 Rozzano, Milano, Italy. Fax: 0039-2-8224-4691; e-mail:


GASPARINI, M., et al.: Relief of Drug Refractory Angina by Biventricular Pacing in Heart Failure.Since cardiac resynchronization therapy (CRT) improves LV function at the cost of low energetic expenditure, the authors hypothesized that it may increase the threshold of drug refractory angina in selected patients with CHF and CAD who are not amenable to myocardial revascularization. From October 1999 to April 2002, 75 patients with CHF and CAD were treated with CRT. Drug refractory angina occurred nearly daily in 8 of the 75 patients. The mean age of these eight men was 71 years, mean NYHA functional Class3.4 ± 0.5, mean QRS duration (QRSd)168 ± 20  ms, and mean left ventricular ejection fraction (LVEF)0.29 ± 0.4. Diffuse CAD not amenable to myocardial revascularization was confirmed on angiography. At baseline, no patient was able to complete a 6-minute walk test because of angina. In the 6 months before CRT, the mean number of hospitalizations per patient for management of CHF or angina was3.1 ± 0.3. All patients underwent successful CRT. Mean QRSd decreased to141 ± 16  ms (P = 0.01vs baseline). After9 ± 6.1  months, LVEF increased to0.317 ± 0.028(P = 0.03vs baseline), while the NYHA class decreased to2.6 ± 0.5(P = 0.02vs baseline). All patients also experienced a marked decrease in angina episodes, from a mean of8.3 ± 11.6to0.6 ± 1.3episodes/week(P < 0.05), and completed a 6-minute walk test, covering a mean distance of337 ± 68  m(vs237 ± 136  mat baseline,P = 0.007). No further hospitalization was necessary. The beneficial effects of CRT on overall cardiac function may include a better control of angina in severely symptomatic patients. (Pace 2003; 26[Pt. II]:181–184)