This innovative, pacemaker-based approach to the treatment of patients with heart failure who have a wide QRS complex (>140 ms) on 12-lead ECG aims at providing electromechanical coordination and improved ventricular synchrony in symptomatic patients who have severe systolic dysfunction and clinically significant intraventricular conduction defects, particularly left bundle-branch block. A percutaneous, three-lead, biventricular pacemaker system is used; one lead is placed in the right atrium, one is placed in the right ventricle, and a third is passed through the right atrium, through the coronary sinus, and into a cardiac vein on the lateral wall of the left ventricle.
Beneficial effects include reverse remodeling, resulting in decreased heart size and ventricular volumes, improved ejection fraction, and decreased mitral regurgitation. Clinical improvements in exercise tolerance, quality of life, and the rate of hospitalization have been documented. However resynchronization therapy has not been shown to enhance survival.