Implantable cardioverter defibrillator (ICD) with biventricular pacing (BiV) is available for drug- refractory heart failure patient who has class I indication for ICD and inter-ventricular conduction delay. We studied 32 patients with mean age of 61 years (M:F=9:1) with mean ejection fraction about 30% who has underwent implantation of implantable cardioverter defibrillator incorporated with left ventricular pacing. It showed its efficacy in terms of improvement in functional status and ejection fraction as confirmed by echocardiogram, episodes of cardiac related rehospitalization (p<0.05) and appropriate therapy for ventricular tachycardia among our patients in the mean follow up period of 22 months. Permanent left ventricular pacing is achieved by pacing of the distal branches of coronary sinus with a specially designed left ventricular (LV) lead. The optimal placement of LV lead is identified by a satisfactory pacing threshold, ventricular sensing and late sensing of LV electrical activity in order to optimize the resynchronization process. At the end of follow-up, all LV leads were fully functional with stable thresholds and appropriate sensing. Eight episodes of ventricular fibrillation and 18 episodes of ventricular tachycardia were successfully detected. The detection of ventricular arrhythmia detection was 100%. Four patients received 28 inappropriate shocks secondary to supraventricular tachycardia.

Conclusion: Implantable cardioverter defibrillator incorporated with biventricular pacing is an efficient and safe mean of providing patient with cardiac resynchronization therapy in patient with drug refractory heart failure with interventricular conduction delay.