101
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:1810-52. [PMID: 23741057 DOI: 10.1161/cir.0b013e31829e8807] [Citation(s) in RCA: 2325] [Impact Index Per Article: 211.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Clyde W Yancy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
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102
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Khan MA, Neyses L, Mamas MA. Atrial fibrillation in heart failure: an innocent bystander? Curr Cardiol Rev 2013; 8:273-80. [PMID: 22920477 PMCID: PMC3492811 DOI: 10.2174/157340312803760839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 05/01/2012] [Accepted: 06/20/2012] [Indexed: 12/21/2022] Open
Abstract
Heart failure (HF) and atrial fibrillation (AF) frequently coexist and each complicates the course of the other. The purpose of this review is to analyse the prognostic impact of AF in patients with HF and assess whether there is an advantage in targeting therapies towards the maintenance of sinus rhythm (SR) in this cohort of patients. The presence of AF in patients with HF has been reported to be independently associated with an increase in mortality in many studies and this increased risk is observed in those with both preserved and impaired LV systolic function. The optimal strategy for targeting AF in patients with HF is unclear but recent randomised controlled studies indicate no significant prognostic advantage associated with a rhythm control strategy as compared to a rate control strategy. A number of small studies have investigated the role of both cardiac resynchronization therapy (CRT) and AF catheter ablation for the maintenance of / conversion to SR in patients with HF with initial promising results although larger randomised controlled studies will need to be performed to define the role of these modalities in the treatment of this cohort and whether preliminary benefits observed in these studies translate to improvements in longer term prognosis. Finally, there has been a focus on modifying the arrhythmogenic atrial substrate and neurohormonal milieu by pharmacological means in order to prevent AF although it remains to be seen whether this approach proves to be efficacious with improvements in clinically relevant outcomes.
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Affiliation(s)
- M A Khan
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9PT, UK
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103
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Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD, Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Ettinger SM, Guyton RA, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2013; 144:e127-45. [PMID: 23140976 DOI: 10.1016/j.jtcvs.2012.08.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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104
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 560] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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105
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2012; 127:e283-352. [PMID: 23255456 DOI: 10.1161/cir.0b013e318276ce9b] [Citation(s) in RCA: 376] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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106
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Tracy CM, Epstein AE, Darbar D, Dimarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Heart Rhythm 2012; 9:1737-53. [PMID: 22975672 DOI: 10.1016/j.hrthm.2012.08.021] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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107
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Tracy CM, Epstein AE, Darbar D, Dimarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012; 60:1297-313. [PMID: 22975230 DOI: 10.1016/j.jacc.2012.07.009] [Citation(s) in RCA: 229] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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108
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Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD, Ellenbogen KA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hayes DL, Page RL, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. [corrected]. Circulation 2012; 126:1784-800. [PMID: 22965336 DOI: 10.1161/cir.0b013e3182618569] [Citation(s) in RCA: 239] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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109
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Abstract
Despite the development of newer drugs and procedures to improve rhythm control, there is still a place for ablation of the atrioventricular junction (AVJ) in the management of selected patients with AF who are refractory to medical therapy, to improve quality of life, prevent ventricular dysfunction, and to optimize cardiac resynchronization therapy. We review all aspects of the "ablate and pace" strategy, from its history to patient selection, technique, outcomes and applications, and identify the need for randomized clinical trials to address some of the remaining questions regarding its application in some groups of patients.
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Affiliation(s)
- Alexandru B Chicos
- Division of Cardiology, Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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110
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Terapia de resincronización cardiaca. Indicaciones y contraindicaciones. Rev Esp Cardiol 2012; 65:843-9. [DOI: 10.1016/j.recesp.2012.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 02/24/2012] [Indexed: 12/20/2022]
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111
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Stavrakis S, Garabelli P, Reynolds DW. Cardiac resynchronization therapy after atrioventricular junction ablation for symptomatic atrial fibrillation: a meta-analysis. Europace 2012; 14:1490-7. [PMID: 22696519 DOI: 10.1093/europace/eus193] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrioventricular junction (AVJ) ablation with permanent pacing improves symptoms in selected patients with atrial fibrillation (AF). The optimal pacing modality after AVJ ablation remains unclear. We performed a meta-analysis of randomized controlled trials to examine whether cardiac resynchronization therapy (CRT) is superior to right ventricular (RV) pacing in this patient population. METHODS AND RESULTS We searched the MEDLINE and EMBASE databases for studies evaluating the effect of CRT vs. RV pacing after AVJ ablation for AF. Pooled risk ratios (RRs) and mean differences with 95% confidence intervals (CIs) were calculated for categorical and continuous outcomes, respectively, using a random effects model. Five trials involving 686 patients (413 in CRT and 273 in RV pacing group) were included in the analysis. On the basis of the pooled estimate across the studies, CRT resulted in a non-significant reduction in mortality (RR = 0.75, 95% CI 0.43-1.30; P= 0.30) and a significant reduction in hospitalizations for heart failure (RR = 0.38, 95% CI = 0.17-0.85; P= 0.02) compared with RV pacing. Cardiac resynchronization therapy did not improve 6 min walk distance (mean difference 15.7, 95% CI -7.2 to 38.5 m; P= 0.18) and Minnesota Living with Heart Failure quality-of-life score (mean difference -3.0, 95% CI -8.6 to 2.6; P= 0.30) compared with RV pacing. The change in left ventricular ejection fraction between baseline and 6 months favoured CRT (mean change 2.0%, 95% CI 1.5-2.4%; P< 0.001). CONCLUSION Cardiac resynchronization therapy may be superior to RV pacing in patients undergoing AVJ ablation for AF. Further studies, adequately powered to detect clinical outcomes, are required.
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Affiliation(s)
- Stavros Stavrakis
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd, WP 3010, Oklahoma City, OK 73104, USA.
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112
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Latchamsetty R, Morady F. A Patient with a 40% Ejection Fraction Undergoes Atrioventricular Nodal Ablation for the Management of Atrial Fibrillation with Rapid Ventricular Rates. What Type of Device Should He Receive? Card Electrophysiol Clin 2012; 4:143-149. [PMID: 26939811 DOI: 10.1016/j.ccep.2012.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patients with symptomatic atrial fibrillation not amenable to pharmacologic therapy or catheter ablation may be appropriate candidates for atrioventricular nodal (AVN) ablation and placement of a permanent pacemaker. The question arises as to whether to implant a right ventricular (RV)-only pacing device or a cardiac resynchronization therapy (CRT) device. This article examines 2 similar cases of patients presenting for AVN ablation who received RV-only pacing devices but had different clinical outcomes. This article discusses existing guidelines and studies that can help clinicians address the challenging question of whether an initial implant of a CRT pacing device is warranted in such patients.
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Affiliation(s)
- Rakesh Latchamsetty
- Division of Electrophysiology, Cardiovascular Center, University of Michigan Hospital, #2396B, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA
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113
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Tan TC, Sindone AP, Denniss AR. Cardiac Electronic Implantable Devices in the Treatment of Heart Failure. Heart Lung Circ 2012; 21:338-51. [DOI: 10.1016/j.hlc.2012.03.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 03/26/2012] [Accepted: 03/31/2012] [Indexed: 10/28/2022]
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114
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Abstract
The right ventricular (RV) apex has been the standard pacing site since the development of implantable pacemaker technology. Although RV pacing was initially only utilized for the treatment of severe bradyarrhythmias usually due to complete heart block, today the indications for and implantation of RV pacing devices is dramatically larger. Recently, the adverse effects of chronic RV apical pacing have been described including an increased risk of heart failure and death. This review details the detrimental effects of RV apical pacing and their shared hemodynamic pathophysiology. In particular, the role of RV apical pacing induced ventricular dyssynchrony is highlighted with a specific focus on differential outcome based upon QRS morphology at implant.
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Affiliation(s)
- Andrew Brenyo
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
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115
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Chatterjee NA, Upadhyay GA, Ellenbogen KA, Hayes DL, Singh JP. Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis of biventricular vs. right ventricular pacing mode. Eur J Heart Fail 2012; 14:661-7. [PMID: 22436544 DOI: 10.1093/eurjhf/hfs036] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIMS For patients with refractory atrial fibrillation (AF) undergoing atrioventricular nodal ablation (AVNA), initial single-chamber right ventricular (RV)-only pacing is standard. Given the deleterious effects of chronic RV-only pacing, the impact of an initial biventricular (BiV) pacing strategy post-ablation is of interest. METHODS AND RESULTS We conducted a meta-analysis to determine the effect of BiV vs. RV-only pacing in patients undergoing AVNA for refractory atrial fibrillation. A search of multiple electronic databases identified 921 reports, which included four randomized controlled trials (n = 534). Mean New York Heart Association (NYHA) class was 2.3 and mean left ventricular ejection fraction (LVEF) was 44%. When compared with RV-only pacing, BiV pacing was not associated with reduced mortality [risk ratio 0.85, 95% confidence interval (CI) 0.40-1.82, P = 0.68]. In three studies comprised of patients with left ventricular systolic dysfunction (mean EF 41 ± 3%), BiV pacing demonstrated a non-significant reduction in cardiac mortality (risk ratio 0.59, 95% CI 0.25-1.39; P = 0.23). Compared with RV-only pacing, BiV pacing was associated with significant improvement in symptoms [Minnesota Living with Heart Failure Questionnaire (MLWHFQ) 2.72 points fewer, 95% CI 1.45-3.99] and increased LVEF (+2.6%, 95% CI 1.69-3.44), but no significant change in 6 min walk distance (6MWD) (5.02 ms more, 95% CI -1.56 to 11.59; P = 0.13). CONCLUSIONS In patients with refractory AF undergoing AVNA, BiV pacing was not associated with significantly improved survival when compared with RV-only pacing. A modest, but significant improvement in structural and functional response to BiV pacing was observed.
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Affiliation(s)
- Neal A Chatterjee
- Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02411, USA
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116
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Zabarovskaja S, Gadler F, Braunschweig F, Ståhlberg M, Hörnsten J, Linde C, Lund LH. Women have better long-term prognosis than men after cardiac resynchronization therapy. Europace 2012; 14:1148-55. [PMID: 22399204 DOI: 10.1093/europace/eus039] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stanislava Zabarovskaja
- Section for Heart Failure, Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden
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117
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Abstract
The management of atrial fibrillation has evolved greatly in the past few years, and many areas have had substantial advances or developments. Recognition of the limitations of aspirin and the availability of new oral anticoagulant drugs that overcome the inherent drawbacks associated with warfarin will enable widespread application of effective thromboprophylaxis with oral anticoagulants. The emphasis on stroke risk stratification has shifted towards identification of so-called truly low-risk patients with atrial fibrillation who do not need antithrombotic therapy, whereas oral anticoagulation therapy should be considered in patients with one or more risk factors for stroke. New antiarrhythmic drugs, such as dronedarone and vernakalant, have provided some additional opportunities for rhythm control in atrial fibrillation. However, the management of the disorder is increasingly driven by symptoms. The availability of non-pharmacological approaches, such as ablation, has allowed additional options for the management of atrial fibrillation in patients who are unsuitable for or intolerant of drug approaches.
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Affiliation(s)
- Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
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118
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Chatterjee NA, Upadhyay GA, Ellenbogen KA, McAlister FA, Choudhry NK, Singh JP. Atrioventricular Nodal Ablation in Atrial Fibrillation. Circ Arrhythm Electrophysiol 2012; 5:68-76. [DOI: 10.1161/circep.111.967810] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neal A. Chatterjee
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Gaurav A. Upadhyay
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Kenneth A. Ellenbogen
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Finlay A. McAlister
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Niteesh K. Choudhry
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Jagmeet P. Singh
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
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119
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Right Ventricular Pacing, Mechanical Dyssynchrony, and Heart Failure. J Cardiovasc Transl Res 2011; 5:219-31. [DOI: 10.1007/s12265-011-9341-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/11/2011] [Indexed: 11/25/2022]
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120
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121
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Davy JM, Tri Cung T, Cransac F, Massin F, Tapiero A, Roubille F, Pasquié JL. La fibrillation atriale permanente. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2011. [DOI: 10.1016/s1878-6480(11)70393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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122
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Eleid MF, Shen WK. Role of atrioventricular nodal ablation and pacemaker therapy in elderly patients with recurrent atrial fibrillation. Interv Cardiol 2011. [DOI: 10.2217/ica.11.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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123
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Thibault B, Ducharme A, Harel F, White M, O'Meara E, Guertin MC, Lavoie J, Frasure-Smith N, Dubuc M, Guerra P, Macle L, Rivard L, Roy D, Talajic M, Khairy P. Left Ventricular Versus Simultaneous Biventricular Pacing in Patients With Heart Failure and a QRS Complex ≥120 Milliseconds. Circulation 2011; 124:2874-81. [DOI: 10.1161/circulationaha.111.032904] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Left ventricular (LV) pacing alone may theoretically avoid deleterious effects of right ventricular pacing.
Methods and Results—
In a multicenter, double-blind, crossover trial, we compared the effects of LV and biventricular (BiV) pacing on exercise tolerance and LV remodeling in patients with an LV ejection fraction ≤35%, QRS ≥120 milliseconds, and symptoms of heart failure. A total of 211 patients were recruited from 11 centers. After a run-in period of 2 to 8 weeks, 121 qualifying patients were randomized to LV followed by BiV pacing or vice versa for consecutive 6-month periods. The greatest improvement in New York Heart Association class and 6-minute walk test occurred during the run-in phase before randomization. Exercise duration at 75% of peak V
o
2
(primary outcome) increased from 9.3±6.4 to 14.0±11.9 and 14.3±12.5 minutes with LV and BiV pacing, respectively, with no difference between groups (
P
=0.4327). LV ejection fraction improved from 24.4±6.3% to 31.9±10.8% and 30.9±9.8% with LV and BiV pacing, respectively, with no difference between groups (
P
=0.4530). Reductions in LV end-systolic volume were likewise similar (
P
=0.6788). The proportion of clinical responders (≥20% increase in exercise duration) to LV and BiV pacing was 48.0% and 55.1% (
P
=0.1615). Positive remodeling responses (≥15% reduction in LV end-systolic volume) were observed in 46.7% and 55.4% (
P
=0.0881). Overall, 30.6% of LV nonresponders improved with BiV and 17.1% of BiV nonresponders improved with LV pacing.
Conclusion—
LV pacing is not superior to BiV pacing. However, nonresponders to BiV pacing may respond favorably to LV pacing, suggesting a potential role as tiered therapy.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00901212.
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Affiliation(s)
- Bernard Thibault
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Anique Ducharme
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - François Harel
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Michel White
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Eileen O'Meara
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Marie-Claude Guertin
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Joel Lavoie
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Nancy Frasure-Smith
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Marc Dubuc
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Peter Guerra
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Laurent Macle
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Léna Rivard
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Denis Roy
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Mario Talajic
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
| | - Paul Khairy
- From the Montreal Heart Institute and Université de Montréal (B.T., A.D., F.H., M.W., E.O., J.L., M.D., P.G., L.M., L.R., D.R., M.T., P.K.), Montreal Heart Institute Coordinating Centre (M.-C.G.), and Centre Hospitalier de l'Université McGill (N.F.-S.), Montréal, Québec, Canada
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Mihálcz A, Ábrahám P, Kardos A, Földesi C, Szili-Török T. Cardiac resynchronization therapy for patients with atrial fibrillation. Orv Hetil 2011; 152:1757-63. [DOI: 10.1556/oh.2011.29204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Atrial fibrillation and chronic heart failure are two major and even growing cardiovascular conditions that often coexist. Cardiac resynchronization therapy is an important, device-based, non-pharmacological approach in a selected group of chronic heart failure patients that has been shown to improve left ventricular function and to reduce both morbidity and mortality in large randomized trials. The latest European and American guidelines have considered atrial fibrillation patients with heart failure eligible for cardiac resynchronization therapy. This review summarizes current literature concerning the following topics: prognostic relevance of atrial fibrillation in heart failure, effects of cardiac resynchronization therapy in atrial fibrillation, relevance and strategies of rhythm and rate control in this group of patients. Authors explain how atrial fibrillation may interfere with the delivery of adequate cardiac resynchronization therapy, how to reduce the burden of atrial tachyarrhythmias, and finally present a brief overview. Orv. Hetil., 2011, 152, 1757–1763.
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Affiliation(s)
- Attila Mihálcz
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
| | - Pál Ábrahám
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
| | - Attila Kardos
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
| | - Csaba Földesi
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
| | - Tamás Szili-Török
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
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Brignole M, Botto G, Mont L, Iacopino S, De Marchi G, Oddone D, Luzi M, Tolosana JM, Navazio A, Menozzi C. Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial. Eur Heart J 2011; 32:2420-9. [PMID: 21606084 DOI: 10.1093/eurheartj/ehr162] [Citation(s) in RCA: 240] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to conventional right ventricular (RV) pacing in reducing heart failure (HF) events. METHODS AND RESULTS In this prospective, multi-centre study, we randomly assigned 186 patients, in whom AV junction ablation and CRT device implantation had been successfully performed, to receive optimized echo-guided CRT (97 patients) or RV apical pacing (89 patients). The data were analysed according to the intention-to-treat principle. During a median follow-up of 20 months (interquartile range 11-24), the primary composite endpoint of death from HF, hospitalization due to HF, or worsening HF occurred in 11 (11%) patients in the CRT group and 23 (26%) patients in the RV group [CRT vs. RV group: sub-hazard ratio (SHR) 0.37 ( 95% CI 0.18-0.73), P = 0.005]. In the CRT group, compared with the RV group, fewer patients had worsening HF [SHR 0.27 (95% CI 0.12-0.58), P = 0.001] and hospitalizations for HF [SHR 0.20 (95% CI 0.06-0.72), P = 0.013]. Total mortality was similar in both groups [hazard ratio (HR) 1.57 (95% CI 0.58-4.27), P = 0.372]. The beneficial effects of CRT were consistent in patients who had ejection fraction ≤35%, New York Heart Association Class ≥III and QRS width ≥120 and in those who did not. At multi-variable Cox regression, only CRT mode remained an independent predictor of absence of clinical failure during the follow-up [HR = 0.23 (95% CI 0.08-0.66), P = 0.007]. CONCLUSIONS In patients undergoing 'Ablate and Pace' therapy for severely symptomatic permanent atrial fibrillation, CRT is superior to RV apical pacing in reducing the clinical manifestations of HF. (ClinicalTrials.gov number: NCT00111527).
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Affiliation(s)
- Michele Brignole
- Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, 16033 Lavagna, Italy.
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HM DELNOY PETERPAUL, OTTERVANGER JANPAUL, VOS DICKHS, ELVAN ARIF, MISIER ANANDRRAMDAT, BEUKEMA WILLEMP, STEENDIJK PAUL, VAN HEMEL NORBERTM. Upgrading to Biventricular Pacing Guided by Pressure-Volume Loop Analysis During Implantation. J Cardiovasc Electrophysiol 2010; 22:677-83. [DOI: 10.1111/j.1540-8167.2010.01968.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Leclercq C, Padeletti L, Cihák R, Ritter P, Milasinovic G, Gras D, Paul V, Van Gelder IC, Stellbrink C, Rieger G, Corbucci G, Albers B, Daubert JC. Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics. Europace 2010; 12:71-7. [PMID: 19864311 DOI: 10.1093/europace/eup318] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the incidence over time of PAT in HF patients treated with CRT. METHODS AND RESULTS Consecutive patients in NYHA functional class III or IV despite optimal drug therapy, QRS duration > or = 130 ms, left ventricular ejection fraction < or = 35%, and left ventricular end-diastolic dimension > or = 55 mm were eligible for enrolment. Patients with permanent or persistent atrial fibrillation (AF) were not included in the study. The first follow-up examination was performed 2 weeks after implantation, to optimize atrial sensing and CRT. Subsequent follow-up examinations were carried out 15 and 28 weeks after implantation, to collect the telemetric data. A total of 173 patients (67 +/- 11 years, M 116) were enrolled. Complete arrhythmia monitoring data were available from 120 patients over a mean follow-up of 183 +/- 23 days. Atrial tachycardia episodes were detected through telemetry in 25 of 120 patients (21%) during at least one follow-up examination. Atrial tachycardia episodes were recorded in 29 and 17% (P = NS) of patients with and without previous history of AF, respectively. CONCLUSION More than 20% of the overall HF patient population treated with CRT suffer PAT episodes. Paroxysmal atrial tachycardia may interfere with response to CRT. Therefore, telemetric data may be relevant to drive the appropriate therapy in each patient.
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Affiliation(s)
- C Leclercq
- Hôpital Pôntchaillou CHU, University of Rennes, Rennes, France.
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Gasparini M, Regoli F, Galimberti P, Ceriotti C, Cappelleri A. Cardiac resynchronization therapy in heart failure patients with atrial fibrillation. Europace 2010; 11 Suppl 5:v82-6. [PMID: 19861396 PMCID: PMC2768583 DOI: 10.1093/europace/eup273] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an important device-based, non-pharmacological approach that has shown, in large randomized trials, to improve left ventricular (LV) function and reduce both morbidity and mortality rates in selected patients affected by advanced heart failure (HF): New York Heart Association (NYHA) functional class III–IV, reduced LV systolic function with an ejection fraction (EF) ≤35%, QRS duration ≥120 ms, on optimal medical therapy, and who were in sinus rhythm. For the first time, the latest ESC and AHA/ACC/HRS Guidelines have considered atrial fibrillation (AF) patients, who constitute an important subgroup of HF patients, as eligible to receive CRT. Nevertheless, these Guidelines did not include a strategy for defining differentiated approaches according to AF duration or burden. In this review, the authors explain in which way AF may interfere with adequate CRT delivery, how to manage different AF burden, and finally present a brief overview on the effects of CRT in AF patients.
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Affiliation(s)
- Maurizio Gasparini
- IRCCS Istituto Clinico Humanitas, Via Manzoni 56, Rozzano/Milano, Italy.
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129
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Biventricular pacing improves cardiac function and prevents further left atrial remodeling in patients with symptomatic atrial fibrillation after atrioventricular node ablation. Am Heart J 2010; 159:264-70. [PMID: 20152225 DOI: 10.1016/j.ahj.2009.11.012] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 11/12/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Randomized trials have demonstrated benefits of biventricular (BiV) pacing in patients with advanced heart failure, intraventricular conduction delay, and atrial fibrillation (AF) post-atrioventricular (AV) node ablation. The AV Node Ablation with CLS and CRT Pacing Therapies for Treatment of AF trial (AVAIL CLS/CRT) was designed to demonstrate superiority of BiV pacing in patients with AF after AV node ablation, to evaluate its effects on cardiac structure and function, and to investigate additional benefits of Closed Loop Stimulation (CLS) (BIOTRONIK, Berlin, Germany). METHODS Patients with refractory AF underwent AV node ablation and were randomized (2:2:1) to BiV pacing with CLS, BiV pacing with accelerometer, or right ventricular (RV) pacing. Echocardiography was performed at baseline and 6 months, with paired data available for 108 patients. RESULTS The RV pacing contributed to significant increase in left atrial volume, left ventricular (LV) end-systolic volume, and LV mass compared to BiV pacing. Ejection fraction decreased insignificantly with RV pacing compared to significant increase with BiV pacing. Interventricular dyssynchrony significantly decreased with BiV compared with RV pacing. Closed Loop Stimulation did not result in additional echocardiographic changes; heart rate distribution was significantly wider with CLS. All groups showed significant improvement in 6-minute walk distance, quality-of-life score, and New York Heart Association class. CONCLUSION In conclusion, RV pacing results in significant increase in left atrial volume, LV mass, and worsening of LV contractility compared to patients receiving BiV pacing post-AV node ablation for refractory AF. Closed Loop Stimulation was not associated with additional structural changes but resulted in significantly wider heart rate distribution.
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130
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Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol 2009; 54:764-76. [PMID: 19695453 DOI: 10.1016/j.jacc.2009.06.006] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
Cardiac pacing is the only effective treatment for patients with sick sinus syndrome and atrioventricular conduction disorders. In cardiac pacing, the endocardial pacing lead is typically positioned at the right ventricular (RV) apex. At the same time, there is increasing indirect evidence, derived from large pacing mode selection trials and observational studies, that conventional RV apical pacing may have detrimental effects on cardiac structure and left ventricular function, which are associated with the development of heart failure. These detrimental effects may be related to the abnormal electrical and mechanical activation pattern of the ventricles (or ventricular dyssynchrony) caused by RV apical pacing. Still, it remains uncertain if the deterioration of left ventricular function as noted in a proportion of patients receiving RV apical pacing is directly related to acutely induced left ventricular dyssynchrony. The upgrade from RV pacing to cardiac resynchronization therapy may partially reverse the deleterious effects of RV pacing. It has even been suggested that selected patients with a conventional pacemaker indication should receive cardiac resynchronization therapy to avoid the deleterious effects. This review will provide a contemporary overview of the available evidence on the detrimental effects of RV apical pacing. Furthermore, the available alternatives for patients with a standard pacemaker indication will be discussed. In particular, the role of cardiac resynchronization therapy and alternative RV pacing sites in these patients will be reviewed.
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Affiliation(s)
- Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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131
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Schlösser M, Stellbrink C. [Indication for CRT]. Herzschrittmacherther Elektrophysiol 2009; 20:103-108. [PMID: 19730926 DOI: 10.1007/s00399-009-0050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 08/19/2009] [Indexed: 05/28/2023]
Abstract
Since the first studies on cardiac resynchronization therapy (CRT), the evidence for the benefit of this electrical therapy in heart failure has continuously grown. Thus, CRT has been firmly implemented in current therapy guidelines for heart failure. However, there are distinct differences between the different guidelines published. In addition, indications for CRT are still evolving in certain patient groups. This article aims to give an overview of the current guidelines for CRT and also discusses some of the differences between the different guidelines. It also provides an outlook for potential candidates for CRT in the future where current guidelines do not yet define a clear indication for implantation of such a device.
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Affiliation(s)
- M Schlösser
- Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Teutoburger Str. 50, 33604 Bielefeld, Deutschland.
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132
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Heart failure (and not only heart failure) and atrial fibrillation: an opening gap between evidence and practice. COR ET VASA 2009. [DOI: 10.33678/cor.2009.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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133
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Delnoy PPHM, Ottervanger JP, Luttikhuis HO, Elvan A, Misier ARR, Beukema WP, van Hemel NM. Long-term clinical response of cardiac resynchronization after chronic right ventricular pacing. Am J Cardiol 2009; 104:116-21. [PMID: 19576330 DOI: 10.1016/j.amjcard.2009.02.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 11/19/2022]
Abstract
Chronic right ventricular (RV) pacing might elicit unpredictably deleterious effects on left ventricular (LV) function similar to that of native left bundle branch block (LBBB). The objective of the present study was to evaluate the clinical and echocardiographic response to cardiac resynchronization therapy after years of chronic RV pacing. In this prospective observational study of 284 consecutive patients, cardiac resynchronization therapy was performed in 194 patients (68%) with a native LBBB and in 90 patients (32%) with a pacing-induced LBBB after chronic RV pacing (upgraded group). Echocardiographic and clinical parameters were evaluated in both groups at baseline and during 2 years of follow-up. The clinical response was defined as survival with improvement of > or =1 in the New York Heart Association class without heart failure hospitalization. Reverse LV remodeling was defined as LV end-systolic volume reduction of > or =15%. At baseline, the New York Heart Association class, quality of life, and exercise capacity were comparable but the LV ejection fraction was significant greater and the LV volumes were significant smaller in the upgraded group. Changes with time in the clinical parameters, echocardiographic parameters, and clinical response were not significantly different between the 2 groups. Reverse LV remodeling was observed in 86% in the upgraded group versus 78% of the native LBBB group after 1 year (p = 0.39). Survival was not significantly different between the 2 groups. In conclusion, comparable clinical and echocardiographic improvement was seen when resynchronization therapy was applied in patients with preceding chronic RV pacing compared with patients with a native LBBB.
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134
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Neuberger HR, Reil JC, Adam O, Laufs U, Mewis C, Böhm M. Atrial fibrillation in heart failure: current treatment of patients with remodeled atria. Curr Heart Fail Rep 2009; 5:219-25. [PMID: 19032917 DOI: 10.1007/s11897-008-0033-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Atrial fibrillation (AF) and chronic heart failure (CHF) can be caused by each other, and therefore constitute a vicious circle. The prevalence of both conditions is about 1% in industrialized countries and increases with age. Although mortality is increased in heart failure, the additional prognostic relevance of AF in these patients is less clear. AF in patients with CHF can worsen heart failure symptoms, cause complications (eg, stroke), and is difficult to treat. Thus, prevention of AF entirely is an important goal. This review summarizes recent data concerning prognostic relevance, treatment, and means of primary and secondary prevention of AF in patients with CHF.
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Affiliation(s)
- Hans-Ruprecht Neuberger
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, D-66421, Homburg/Saar, Germany.
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Kamath GS, Cotiga D, Koneru JN, Arshad A, Pierce W, Aziz EF, Mandava A, Mittal S, Steinberg JS. The Utility of 12-Lead Holter Monitoring in Patients With Permanent Atrial Fibrillation for the Identification of Nonresponders After Cardiac Resynchronization Therapy. J Am Coll Cardiol 2009; 53:1050-5. [DOI: 10.1016/j.jacc.2008.12.022] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 11/20/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
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POÇI DRITAN, BACKMAN LOTTA, KARLSSON THOMAS, EDVARDSSON NILS. New or Aggravated Heart Failure during Long-Term Right Ventricular Pacing after AV Junctional Catheter Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:209-16. [DOI: 10.1111/j.1540-8159.2008.02204.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Delnoy PPH, Ottervanger JP, Luttikhuis HO, Vos DH, Elvan A, Ramdat Misier AR, Beukema WP, Steendijk P, van Hemel NM. Pressure-volume loop analysis during implantation of biventricular pacemaker/cardiac resynchronization therapy device to optimize right and left ventricular pacing sites. Eur Heart J 2008; 30:797-804. [DOI: 10.1093/eurheartj/ehp011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Ismer B, Körber T, von Knorre GH, Heinke M, Voss W, Werwick K, Melzer C, Butter C, Nienaber CA. [CRT in atrial fibrillation--methodical and apparatus options in decision-making]. Herzschrittmacherther Elektrophysiol 2008; 19 Suppl 1:60-68. [PMID: 19169736 DOI: 10.1007/s00399-008-0605-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Heart failure and atrial fibrillation often coexist, especially with increasing degree of heart failure severity. Under this constellation, the advantage of cardiac resynchronization therapy (CRT) is still under discussion and displayed as an unresolved problem in the guidelines for cardiac stimulation and resynchronization. If ventricular desynchronization can be documented and response to CRT can be expected, the challenge is to interoperatively seek the best left ventricular electrode position and to postoperatively optimize the device in order to achieve the best therapy performance. This situation encourages the development of individualized methods and to utilize innovative apparatus features in order to consolidate individual decisions and to optimize CRT in heart failure with atrial fibrillation.
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Affiliation(s)
- B Ismer
- Universitätsklinikum Rostock, Klinik und Poliklinik für Innere Medizin, Abteilung Kardiologie, Ernst-Heydemann-Strasse 6, 100888, 18057, Rostock, Germany.
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139
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Fröhlig G. [Is resynchronization therapy necessary when optimizing right ventricular stimulation?]. Herzschrittmacherther Elektrophysiol 2008; 19 Suppl 1:25-37. [PMID: 19169732 DOI: 10.1007/s00399-008-0604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cardiac resynchronization therapy (CRT) using biventricular stimulation is hampered by coronary venous imponderabilities, complex implantation procedures, technical malfunctions and complications as well as disappointing responder rates. Despite its pathophysiological soundness and some initial success, the use of AV sequential pacing for the treatment of heart failure has been abandoned because right ventricular (RV) apical stimulation may be detrimental for cardiac mechanics, may worsen heart failure and may increase mortality. Attempts at avoiding desynchronizing effects and improving hemodynamics by pacing from alternative RV sites have been numerous but not convincing. Whether patients with left ventricular dysfunction or overt heart failure may benefit from pacing the RV outflow tract or septum, from dual site RV or His bundle stimulation instead of left ventricular based resynchronization is the topic of this review.
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Affiliation(s)
- G Fröhlig
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kirrberger Strasse, 66424, Homburg, Germany.
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Brignole M, Menozzi C, Botto GL, Mont L, Osca Asensi J, García Medina D, Oddone D, Navazio A, Luzi M, Iacopino S, De Fabrizio G, Proclemer A, Vardas P. Usefulness of echo-guided cardiac resynchronization pacing in patients undergoing "ablate and pace" therapy for permanent atrial fibrillation and effects of heart rate regularization and left ventricular resynchronization. Am J Cardiol 2008; 102:854-60. [PMID: 18805110 DOI: 10.1016/j.amjcard.2008.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 05/14/2008] [Accepted: 05/14/2008] [Indexed: 11/30/2022]
Abstract
An acute comparative study of right ventricular (RV) pacing and echocardiographically guided cardiac resynchronization pacing (CRP) was performed in patients who underwent "ablate and pace" therapy for permanent atrial fibrillation. It was hypothesized that optimized CRP guided by tissue Doppler echocardiography would exert an additive beneficial hemodynamic effect to that of rate regularization achieved through atrioventricular junction ablation. An acute intrapatient comparison of echocardiographic parameters was performed between baseline preablation values and RV pacing and CRP (performed <24 hours after ablation) in 50 patients. Optimized CRP configuration was defined as the modality of pacing corresponding to that of the shortest intra-left ventricular (LV) delay among simultaneous biventricular pacing, sequential biventricular pacing, and single-chamber pacing. The intra-LV delay was defined as the difference between the longest and the shortest activation time in the six basal segments of the left ventricle. Compared with preablation measures, the ejection fraction increased by 10.8% during RV pacing (19% in patients with intra-LV delays <47.5 ms and 3% in those with intra-LV delays >47.5 ms). Compared with RV pacing, CRP caused a 9.2% increase in the ejection fraction, a 6.8% decrease in LV systolic diameter, and a 17.3% decrease in mitral regurgitation area; LV dyssynchrony was reduced from 52 +/- 27 to 21 +/- 12 ms. Similar results were observed in patients with and without depressed systolic function and in patients with and without left bundle branch block. In conclusion, rate regularization achieved through atrioventricular junction ablation and RV pacing provides a favorable hemodynamic effect that is inversely related to the level of LV dyssynchrony. Minimizing LV dyssynchrony by means of optimized CRP yields an additional important benefit.
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Affiliation(s)
- Michele Brignole
- Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy.
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Proclemer A, Allocca G, Gregori D, Bonanno C, Ometto R, Fontanelli A, Mantovan R, Crosato M, Calzolari V, Pavoni D, Facchin D, Rebellato L, Fioretti PM. Radiofrequency ablation of drug-refractory atrial fibrillation: an observational study comparing 'ablate and pace' with pulmonary vein isolation. Europace 2008; 10:1085-90. [DOI: 10.1093/europace/eun197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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143
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Szili-Torok T, Mihalcz A, Jordaens L. The 'Happy Ending Problem' of cardiac pacing? Cardiac resynchronization therapy for patients with atrial fibrillation and heart failure after atrioventricular junction ablation. Europace 2008; 10:779-81. [DOI: 10.1093/europace/eun143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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144
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Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation. Europace 2008; 10:809-15. [DOI: 10.1093/europace/eun135] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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145
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Manolis AS, Sakellariou D, Andrikopoulos GK. Alternate Site Pacing in Patients at Risk for Heart Failure. Angiology 2008; 59:97S-102S. [DOI: 10.1177/0003319708321479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac pacing from the right ventricular apex is the most common site of cardiac pacing. During the last decade, several studies demonstrated the harmful effects of the iatrogenic left bundle branch block, which is observed in cardiac pacing from the right ven- tricular apex. These observations led to an interest in alternative right ventricular pacing sites aiming to achieve a more “physiological” pattern of ventricular activation. Alternate site pacing may involve His bun- dle, other right ventricular sites (outflow or septal sites), or left ventricular sites in either unifocal or bifo- cal or biventricular modes. Pacing from the right ven- tricular outflow tract has been studied extensively. Several studies showed that right ventricular outflow tract pacing has better hemodynamic effects and less harmful influence. Bifocal right ventricular (apical and outflow tract) pacing has been proposed for patients with heart failure where the coronary sinus approach to effect biventricular pacing turns out to be unsuccessful because of various reasons. Some studies examined left ventricular pacing alone as an alternative mode of pacing, and the results were quite encouraging but not conclusive. Finally, in heart failure patients not responding to biventricular pacing, the triple site pacing mode has been recently proposed. In triple site pacing, the leads are inserted in the right ventricular apex and outflow tract in conjunction with lateral left ventricular pacing. Improvement of exercise capacity and increased ejection fraction were observed with this triventricular pacing. Although more data from specifically designed randomized studies are needed, there are many alternative pacing sites, especially for patients at high risk of heart failure, which seems to be less harmful and better tolerated by the patients.
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Affiliation(s)
- Antonis S. Manolis
- First Department of Cardiology, Evagelismos General
Hospital of Athens, Athens, Greece,
| | - Dimitrios Sakellariou
- First Department of Cardiology, Evagelismos General
Hospital of Athens, Athens, Greece
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146
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Leclercq C, Gadler F, Kranig W, Ellery S, Gras D, Lazarus A, Clémenty J, Boulogne E, Daubert JC. A randomized comparison of triple-site versus dual-site ventricular stimulation in patients with congestive heart failure. J Am Coll Cardiol 2008; 51:1455-62. [PMID: 18402900 DOI: 10.1016/j.jacc.2007.11.074] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 10/26/2007] [Accepted: 11/28/2007] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We compared the effects of triple-site versus dual-site biventricular stimulation in candidates for cardiac resynchronization therapy. BACKGROUND Conventional biventricular stimulation with a single right ventricular (RV) and a single left ventricular (LV) lead is associated with persistence of cardiac dyssynchrony in up to 30% of patients. METHODS This multicenter, single-blind, crossover study enrolled 40 patients (mean age 70 +/- 9 years) with moderate-to-severe heart failure despite optimal drug treatment, a mean LV ejection fraction of 26 +/- 11%, and permanent atrial fibrillation requiring cardiac pacing for slow ventricular rate. A cardiac resynchronization therapy device connected to 1 RV and 2 LV leads, inserted in 2 separate coronary sinus tributaries, was successfully implanted in 34 patients. After 3 months of biventricular stimulation, the patients were randomly assigned to stimulation for 3 months with either 1 RV and 2 LV leads (3-V) or to conventional stimulation with 1 RV and 1 LV lead (2-V), then crossed over for 3 months to the alternate configuration. The primary study end point was quality of ventricular resynchronization (Z ratio). Secondary end points included reverse LV remodeling, quality of life, distance covered during 6-min hall walk, and procedure-related morbidity and mortality. Data from the 6- and 9-month visits were combined to compare end points associated with 2-V versus 3-V. RESULTS Data eligible for protocol-defined analyses were available in 26 patients. No significant difference in Z ratio, quality of life, and 6-min hall walk was observed between 2-V and 3-V. However, a significantly higher LV ejection fraction (27 +/- 11% vs. 35 +/- 11%; p = 0.001) and smaller LV end-systolic volume (157 +/- 69 cm(3) vs. 134 +/- 75 cm(3); p = 0.02) and diameter (57 +/- 12 mm vs. 54 +/- 10 mm; p = 0.02) were observed with 3-V than with 2-V. There was a single minor procedure-related complication. CONCLUSIONS Cardiac resynchronization therapy with 1 RV and 2 LV leads was safe and associated with significantly more LV reverse remodeling than conventional biventricular stimulation.
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147
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Cabrera-Bueno F, Peña-Hernández J, Fernández-Pastor J, Barrera-Cordero A, García-Pinilla JM, Gómez-Doblas JJ, Alzueta-Rodríguez J, de Teresa-Galván E. Beneficio de la terapia de resincronización cardiaca en la fibrilación auricular sin ablación del nodo. Rev Esp Cardiol 2008. [DOI: 10.1157/13117736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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148
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Funck RC, Kölsch S, Maisch B. [Biventricular stimulation for AV block]. Herzschrittmacherther Elektrophysiol 2008; 19:41-47. [PMID: 18330674 DOI: 10.1007/s00399-008-0599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 02/15/2008] [Indexed: 05/26/2023]
Abstract
Since the establishment of cardiac resynchronization therapy in left bundle branch block and mechanical asynchrony, the adverse effects of right ventricular apical pacing have gained increasing scientific interest. The sequelae of "iatrogenic desynchronization" on cardiac structure and function as well as on patients' prognosis could be well documented. "Minimally desynchronizing" stimulation strategies could be an alternative for patients needing ventricular pacing. The search for hemodynamically more advantageous alternative right ventricular pacing sites has failed so far to deliver well validated results, and due to the somewhat higher lead dislodgment rates pure left ventricular pacing cannot be recommended, at least not in pacemaker-dependent patients. Hence there is the question for primary biventricular stimulation in patients with AV block. The results of several biventricular studies with limited numbers of patients have been promising with respect to structural and functional surrogate endpoints. Two major controlled prospective and prognostically orientated studies, the BIOPACE study and the BLOCK-HF study, are currently underway and will report results in the next few years. According to the actual guidelines of the European Society of Cardiology (ESC) the implantation of a biventricular system is recommended in patients with AV block even without left bundle branch block (Class IIa, evidence level C) if they fulfill the remaining criteria that justify the implantation of a biventricular system. According to the guidelines for pacemaker therapy of the German Cardiac Society (GCS) biventricular pacing can be considered in these patients. Both societies do expressly permit the implantation of biventricular systems with ICD backup if indicated.
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Affiliation(s)
- R C Funck
- Universitätsklinikum Giessen und Marburg, Standort Marburg Klinik für Innere Medizin - Kardiologie, Angiologie und Kardioprävention, Marburg.
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149
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Israel CW, Barold SS. Cardiac Resynchronization Therapy in Patients with Atrial Fibrillation: Is Atrial Lead Implantation Necessary? Pacing Clin Electrophysiol 2008; 31:263-5. [PMID: 18307619 DOI: 10.1111/j.1540-8159.2008.00984.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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150
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Tan ES, Rienstra M, Wiesfeld ACP, Schoonderwoerd BA, Hobbel HHF, Van Gelder IC. Long-term outcome of the atrioventricular node ablation and pacemaker implantation for symptomatic refractory atrial fibrillation. Europace 2008; 10:412-8. [PMID: 18272509 DOI: 10.1093/europace/eun020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eng S Tan
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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