Authors' objectives:

To summarise the current research evidence on the effectiveness of atrio-biventricular pacing in severe heart failure.

Authors' recommendations: Ventricular pacing is an emerging treatment option for patients with severe heart failure refractory to medical therapy. There are several cardiac centres in the UK offering resynchronisation, generally within clinical trials. Although preliminary trials suggest a potential clinical benefit and cost savings, full trial results are awaited. - Clinical impact - The patient group to benefit is potentially large, up to 4,200 - 8,400 people in England and Wales. The benefits, over and above medical therapy, need to be confirmed in randomised trials with sufficient follow-up and consideration of long-term benefit and safety. There are still questions about the optimal configuration of pacing, the optimal site for left ventricular lead placement and whether left ventricular pacing is as beneficial as biventricular pacing. Additionally it is uncertain whether the simultaneous combined use of biventricular pacing and implantable cardiac defibrillators (ICDs) adds mortality or morbidity benefit over and above the use of ICDs alone. - Service impact - the introduction of the left biventricular pacing leads requires some additional skills over and above the placement of the right side leads for ordinary pacemakers, although these skills are reportedly easily acquired. - Patient issues - although pacemakers are an invasive treatment option for a disorder currently treated medically (unless cardiac transplantation is considered), they are an already accepted treatment within the community for many other disorders. There are no reported limiting side effects caused by long-term pacing. - Financial and overall NHS impact - The cost of widespread introduction of biventricular pacing cannot be accurately predicted at this stage, but may bring cost savings if effectiveness and reduced hospitalisation is confirmed. The direct cost of implantation and follow up for all potentially eligible patients may fall in the region of 21M - 63M GBP. Relative costs may fall as the market expands and its use becomes more clearly defined.

Authors' methods: Overview

Project Status: Completed

Year Published: 2001

URL for published report: http://www.hsric.nihr.ac.uk/search

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Horizon Scanning Centre

Contact Address: The NIHR Horizon Scanning Centre, Department of Public Health, Epidemiology, and Biostatistics, School of Health and Population Sciences, University of Birmingham, 90 Vincent Drive, Edgbaston, Birmingham, B15 2SP. United Kingdom. Tel: +44 121 414 7831, Fax: +44 121 2269

Contact Name: c.packer@bham.ac.uk

Contact Email: c.packer@bham.ac.uk

Copyright: National Horizon Scanning Centre