Right ventricular bifocal DDD pacing as primary choice for cardiac resynchronization in heart failure patients with severe mitral regurgitation

The Deleterious Consequences of Right Ventricular Apical Pacing: Time to Seek Alternate Site Pacing

“…A modified approach to bifocal pacing, performed at the right ventricular apex and at the roof of the interventricular septum, was applied in 25 patients with heart failure, dilated cardiomyopathy, LBBB, and mitral regurgitation 87 . At 18 months of follow‐up, bifocal right ventricular pacing significantly shortened the QRS duration, reduced mitral regurgitation, improved hemodynamics and quality of life in heart failure patients, by producing ventricular resynchronization by shortening both inter‐ and intraventricular conduction delays.…”

Is Bifocal Right Ventricular Pacing a Viable Form of Cardiac Resynchronization?

“…Most of the reported BiF system implantations (according to standard CRT indications) occurred after unsuccessful LV lead implantation or LV lead malfunction during the chronic phase (Tables II and III). 10–19 Reports of permanent BiF pacing are difficult to interpret because of the small number of patients, wide range of starting LV function, spectrum of underlying heart disease (such as chronic atrial fibrillation), lack of standardization of the RV pacing sites, previously implanted ventricular pacemakers, different endpoints, and varying durations of follow‐up mostly too short. The relatively short duration of follow‐up in the bifocal mode is an important consideration in crossover studies.…”