Dual chamber pacing in the treatment of congestive heart failure

The present work reviews current literature and the authorsʹ experience of dual chamber pacing in the treatment of patients with congestive heart failure (CHF). In these patients, the atrial contribution to ventricular filling may be less than optimal, especially in the presence of first degree atrioventricular block or mitral insufficiency, both of which are common in the elderly subject with CHF. Dual chamber pacing with short atrioventricular delays has proved effective in enhancing ventricular filling and, in selected cases, cardiac output, with improvement in clinical and instrumental parameters of heart failure. However, for an appropriate atrioventricular synchronization of the left chambers during pacing, the interatrial conduction time must be considered, to avoid atrial contraction against a closed mitral valve. Thus, dual chamber pacing may be a treatment option for CHF that fails to respond to medical therapy.