Usefulness of biventricular pacing in patients with congestive heart failure and right bundle branch block

Biventricular pacing (BVP) has recently been proposed for the treatment of drug-refractory congestive heart failure in patients with prolonged QRS duration.(1-4) Inter- and intraventricular conduction delay results in disordered coordination of left ventric(5,6) ular (LV) contraction and relaxation, and BVP pro motes a more coordinated LV contraction and relaxation.(7,8) BVP has been used in patients with left bundle branch block or unspecified prolongation of the QRS complex.(1-3.9,10) Recently, complete right bundle branch block (RBBB) was suggested to be just as important an independent predictor as left bundle branch block of mortality in patients with congestive heart failure.(11) We postulated that BVP might also benefit patients with severe congestive heart failure and complete RBBB on the basis of a concomitant left-sided intraventricular conduction disorder, which is invisible on the surface electrocardiogram. This study describes our experience with BVP in such patients who have drug-resistant congestive heart failure.