1
|
Mao Y, Duchenne J, Yang Y, Garweg C, Yang Y, Sheng X, Zhang J, Ye Y, Wang M, Paton MF, Puvrez A, Vöros G, Ma M, Fu G, Voigt JU. Left bundle branch pacing better preserves ventricular mechanical synchrony than right ventricular pacing: a two-centre study. Eur Heart J Cardiovasc Imaging 2024; 25:328-336. [PMID: 37933672 DOI: 10.1093/ehjci/jead296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
AIMS Left bundle branch pacing (LBBP) has been shown to better maintain electrical synchrony compared with right ventricular pacing (RVP), but little is known about its impact on mechanical synchrony. This study investigates whether LBBP better preserves left ventricular (LV) mechanical synchronicity and function compared with RVP. METHODS AND RESULTS Sixty patients with pacing indication for bradycardia were included: LBBP (n = 31) and RVP (n = 29). Echocardiography was performed before and shortly after pacemaker implantation and at 1-year follow-up. The lateral wall-septal wall (LW-SW) work difference was used as a measure of mechanical dyssynchrony. Septal flash, apical rocking, and septal strain patterns were also assessed. At baseline, LW-SW work difference was small and similar in two groups. SW was markedly decreased, while LW work remained mostly unchanged in RVP, resulting in a larger LW-SW work difference compared with LBBP (1253 ± 687 mmHg·% vs. 439 ± 408 mmHg·%, P < 0.01) at last follow-up. In addition, RVP more often induced septal flash or apical rocking and resulted in more advanced strain patterns compared with LBBP. At 1 year follow-up, LV ejection fraction (EF) and global longitudinal strain (GLS) were more decreased in RVP compared with LBBP (ΔLVEF: -7.4 ± 7.0% vs. 0.3 ± 4.1%; ΔLVGLS: -4.8 ± 4.0% vs. -1.4 ± 2.5%, both P < 0.01). In addition, ΔLW-SW work difference was independently correlated with LV adverse remodelling (r = 0.42, P < 0.01) and LV dysfunction (ΔLVEF: r = -0.61, P < 0.01 and ΔLVGLS: r = -0.38, P = 0.02). CONCLUSION LBBP causes less LV mechanical dyssynchrony than RVP as it preserves a more physiologic electrical conduction. As a consequence, LBBP appears to preserve LV function better than RVP.
Collapse
Affiliation(s)
- Yankai Mao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Yuan Yang
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Christophe Garweg
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Ying Yang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3, Hangzhou 310016, China
| | - Xia Sheng
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3, Hangzhou 310016, China
| | - Jiefang Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3, Hangzhou 310016, China
| | - Yang Ye
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3, Hangzhou 310016, China
| | - Min Wang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3, Hangzhou 310016, China
| | - Maria F Paton
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium
- Leeds Institute of Cardiovascular and Metabolic Medicine, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
- Leeds Cardiovascular Clinical Research Facility, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alexis Puvrez
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Gabor Vöros
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Mingming Ma
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3, Hangzhou 310016, China
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| |
Collapse
|
2
|
Rimskaya EM, Mironova NA, Sokolov SF, Golitsyn SP. [Left bundle branch block - dilated cardiomyopathy - heart failure: common links in the closed pathogenetic chain]. KARDIOLOGIIA 2023; 63:68-76. [PMID: 36880146 DOI: 10.18087/cardio.2023.2.n1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/23/2021] [Indexed: 03/08/2023]
Abstract
This review summarizes the available information on the epidemiology and prognosis of patients with left bundle branch block (LBBB), morphological alterations of the myocardium both resulting in and ensuing LBBB, cardiac biomechanics in LBBB, and possibilities of its correction.
Collapse
Affiliation(s)
- E M Rimskaya
- Chazov National Medical Research Center of Cardiology
| | - N A Mironova
- Chazov National Medical Research Center of Cardiology
| | - S F Sokolov
- Chazov National Medical Research Center of Cardiology
| | - S P Golitsyn
- Chazov National Medical Research Center of Cardiology
| |
Collapse
|
3
|
Adverse effects of right ventricular pacing on cardiac function: prevalence, prevention and treatment with physiologic pacing. Trends Cardiovasc Med 2023; 33:109-122. [PMID: 34742888 DOI: 10.1016/j.tcm.2021.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 02/07/2023]
Abstract
Right ventricular (RV) pacing is the main treatment modality for patients with advanced atrioventricular (AV) block. Chronic RV pacing can cause cardiac systolic dysfunction and heart failure (HF). In this review, we discuss studies that have shown deleterious effects of chronic RV pacing on systolic cardiac function causing pacing-induced cardiomyopathy (PiCM), heart failure (HF), HF hospitalization, atrial fibrillation (AF) and cardiac mortality. RV apical pacing is the most widely used and studied. Adverse effects of RV pacing appear to be directly related to pacing burden and are worse in patients with pre-existing left ventricular (LV) dysfunction. Chronic RV pacing is also associated with heart failure with preserved ejection fraction (HFpEF). Mechanisms, risk factors, clinical and echocardiographic features, and strategies to minimize RV pacing-induced cardiac dysfunction are discussed in light of the latest data. Studies on biventricular (Bi-V) pacing upgrade in patients who develop RV PiCM, use of alternate RV pacing sites, de novo Bi-V pacing, and physiologic pacing using HIS bundle pacing (HBP) and left bundle area (LBBA) pacing in patients with an anticipated high RV pacing burden are discussed.
Collapse
|
4
|
Chango Azanza DX, Munín MA, Raggio I, Perea G, Carbajales J. [Different phenotypes of mitral regurgitation in patients with right apical ventricular pacing: an echocardiographic approach in a heterogeneity of clinical scenarios]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:112-120. [PMID: 38274564 PMCID: PMC10809778 DOI: 10.47487/apcyccv.v2i2.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2024]
Abstract
The presence of mitral regurgitation (MR) in patients with right ventricular apical pacing can be the result of multiple phenomena. On the one hand, this stimulation causes an asynchronous activation of the left ventricle (LV) and the papillary muscles, leading to a deterioration of the LV ejection fraction and causing an inadequate closure of the valve apparatus. However, there is a wide heterogeneity of ischemic and non-ischemic myocardial conditions that can coexist with mechanical alteration of the LV and the mitral valve leading to or worsening MR in these patients, which can make the etiological determination of valvular regurgitation difficult. Transthoracic echocardiography study allows comprehensive evaluation of mitral valve regurgitation and ventricular function parameters and mechanical asynchrony as a result of artificial pacing. The comprehensive study of these phenomena is relevant in clinical decision-making to define those patients who benefit from cardiac resynchronization therapy to alleviate symptomatic MR.
Collapse
Affiliation(s)
- Diego Xavier Chango Azanza
- Departamento de Cardiología. Hospital General de Agudos «Ramos Mejía». Buenos Aires, Argentina. Departamento de CardiologíaHospital General de Agudos «Ramos MejíaBuenos AiresArgentina
| | - Martín Alejandro Munín
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Ignacio Raggio
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Gabriel Perea
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Justo Carbajales
- Departamento de Cardiología. Hospital General de Agudos «Ramos Mejía». Buenos Aires, Argentina. Departamento de CardiologíaHospital General de Agudos «Ramos MejíaBuenos AiresArgentina
| |
Collapse
|
5
|
Effects of cardiac pacemakers on left ventricular volumes and function assessed by 3D echocardiography, Doppler method, and global longitudinal strain. Egypt Heart J 2021; 73:16. [PMID: 33616794 PMCID: PMC7900307 DOI: 10.1186/s43044-021-00138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Many previous studies reported the negative effects of right ventricular (RV) pacing on the left ventricular (LV) structure and ejection fraction. Studying pacing hemodynamics is essential to understand these detrimental effects. In this study, we tried to understand RV pacing effects on LV volumes and function using advanced tools like 3D echo and global longitudinal strain (GLS). This was a prospective study of 175 consecutive patients (LVEF>50%) presented permanent pacing. Of 175 patients, only 50 patients met study criteria, divided into two groups (single or dual pacing). LV volumes and function were assessed by full-volume 3D echocardiography and GLS before pacing, at 1-week and 6-month post-pacing. Cardiac output (COP) was calculated by pulsed wave Doppler method and 3D echo. Results Doppler method results were similar to 3D echo in calculating SV and COP. At 1-week post pacing, both groups showed a significant decrease in SV due to a drop in EDV while ESV did not change significantly. Despite the drop in SV, there was a significant increase in cardiac output (COP) due to achieving higher heart rates post-pacing. There was a significant drop in EF and GLS in both groups. At 6 months, SV continued to decrease with a corresponding decrease in COP and LVEF. This drop in SV was due to a significant increase in ESV while EDV did not show a significant change at a 6-month follow-up. Also, the drop EF and GLS became more significant. There were no significant differences between both groups regarding the changes in LV volumes (EDV, ESV, SV), LVEF or GLS throughout the study (pre-pacing, at 1-week and 6-months post pacing). However, dual-chamber pacing group provided higher heart rates and as a result higher COP than the single-chamber group. Conclusions RV pacing led to a significant drop in LV COP, ejection fraction (EF), and GLS over short- and long-term duration. Dual chamber pacing provided higher COP than a single chamber pacing. This was due to tracking the S. A node with pacing at higher heart rates not due to an increase in SV and preserving atrioventricular synchrony. Both Doppler method and 3D echo can be used to calculate SV and COP. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00138-9.
Collapse
|
6
|
Stanley A, Athanasuleas C, Buckberg G. How His bundle pacing prevents and reverses heart failure induced by right ventricular pacing. Heart Fail Rev 2020; 26:1311-1324. [PMID: 32318885 DOI: 10.1007/s10741-020-09962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ideal heart performance demands vigorous systolic contractions and rapid diastolic relaxation. These sequential events are precisely timed and interdependent and require the rapid synchronous electrical stimulation provided by the His-Purkinje system. Right ventricular (RV) pacing creates slow asynchronous electrical stimulation that disrupts the timing of the cardiac cycle and results in left ventricular (LV) mechanical asynchrony. Long-term mechanical asynchrony produces LV dysfunction, remodeling, and clinical heart failure. His bundle pacing preserves synchronous electrical and mechanical LV function, prevents or reverses RV pacemaker-induced remodeling, and reduces heart failure.
Collapse
Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham, AL, USA
| | - Constantine Athanasuleas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald Buckberg
- Division of Cardiac Surgery, Department of Surgery, Cardiovascular Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| |
Collapse
|
7
|
Lin YS, Chang TH, Shi CS, Wang YZ, Ho WC, Huang HD, Chang ST, Pan KL, Chen MC. Liver X Receptor/Retinoid X Receptor Pathway Plays a Regulatory Role in Pacing-Induced Cardiomyopathy. J Am Heart Assoc 2020; 8:e009146. [PMID: 30612502 PMCID: PMC6405706 DOI: 10.1161/jaha.118.009146] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The molecular mechanisms through which high‐demand pacing induce myocardial dysfunction remain unclear. Methods and Results We created atrioventricular block in pigs using dependent right ventricular septal pacing for 6 months. Echocardiography was performed to evaluate dyssynchrony between pacing (n=6) and sham control (n=6) groups. Microarray and enrichment analyses were used to identify differentially expressed genes (DEGs) in the left ventricular (LV) myocardium between pacing and sham control groups. Histopathological and protein changes were also analyzed and an A cell pacing model was also performed. Pacing significantly increased mechanical dyssynchrony. Enrichment analysis using Ingenuity Pathway Analysis and the activation z‐score analysis method demonstrated that there were 5 DEGs (ABCA1, APOD, CLU, LY96, and SERPINF1) in the LV septum (z‐score=−0.447) and 5 DEGs (APOD, CLU, LY96, MSR1, and SERPINF1) in the LV free wall (z‐score=−1.000) inhibited the liver X receptor/retinoid X receptor (LXR/RXR) pathway, and 4 DEGs (ACTA2, MYL1, PPP2R3A, and SNAI2) activated the integrin‐linked kinase (ILK) pathway in the LV septum (z‐score=1.000). The pacing group had a larger cell size, higher degree of myolysis and fibrosis, and increased expression of intracellular lipid, inflammatory cytokines, and apoptotic markers than the sham control group. The causal relationships between pacing and DEGs related to LXR/RXR and ILK pathways, apoptosis, fibrosis, and lipid expression after pacing were confirmed in the cell pacing model. Luciferase reporter assay in the cell pacing model also supported inhibition of the LXR pathway by pacing. Conclusions Right ventricular septal‐dependent pacing was associated with persistent LV dyssynchrony–induced cardiomyopathy through inhibition of the LXR/RXR pathway.
Collapse
Affiliation(s)
- Yu-Sheng Lin
- 1 Division of Cardiology Chang Gung Memorial Hospital Chiayi Taiwan.,2 Graduate Institute of Clinical Medical Sciences College of Medicine Chang Gung University Taoyuan Taiwan
| | - Tzu-Hao Chang
- 3 Graduate Institute of Biomedical Informatics Taipei Medical University Taipei Taiwan
| | - Chung-Sheng Shi
- 2 Graduate Institute of Clinical Medical Sciences College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yi-Zhen Wang
- 4 Division of Cardiology Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Wan-Chun Ho
- 4 Division of Cardiology Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Hsien-Da Huang
- 5 The Warshel Institute of Computational Biology School of Science and Technology The Chinese University of Hong Kong Shenzhen China.,6 Department of Biological Science and Technology National Chiao Tung University Hsinchu Taiwan
| | - Shih-Tai Chang
- 1 Division of Cardiology Chang Gung Memorial Hospital Chiayi Taiwan
| | - Kuo-Li Pan
- 1 Division of Cardiology Chang Gung Memorial Hospital Chiayi Taiwan
| | - Mien-Cheng Chen
- 4 Division of Cardiology Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung Taiwan
| |
Collapse
|
8
|
Khurwolah MR, Yao J, Kong XQ. Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function. Curr Cardiol Rev 2019; 15:145-155. [PMID: 30499419 PMCID: PMC6520581 DOI: 10.2174/1573403x15666181129161839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
Several studies have focused on the deleterious consequences of Right Ventricular Apical (RVA) pacing on Left Ventricular (LV) function, mediated by pacing-induced ventricular dyssyn-chrony. Therapeutic strategies to reduce the detrimental consequences of RVA pacing have been pro-posed, that includes upgrading of RVA pacing to Cardiac Resynchronization Therapy (CRT), alterna-tive Right Ventricular (RV) pacing sites, minimal ventricular pacing strategies, as well as atrial-based pacing. In developing countries, single chamber RV pacing still constitutes a majority of cases of permanent pacing, and assessment of the optimal RV pacing site is of paramount importance. In chronically-paced patients, it is crucial to maintain as close and normal LV physiological function as possible, by minimizing ventricular dyssynchrony, reducing the chances for heart failure and other complications to develop. This review provides an analysis of the deleterious immediate and long-term consequences of RVA pacing, and the most recent available evidence regarding improvements in pacing options and strategies to optimize LV diastolic and systolic function. Furthermore, the place of advanced echocardiography in the identification of patients with pacing-induced LV dysfunction, the potential role of a new predictor of LV dysfunction in RV-paced subjects, and the long- term out-comes of patients with RV septal pacing will be explored
Collapse
Affiliation(s)
- Mohammad Reeaze Khurwolah
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Jing Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Xiang-Qing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| |
Collapse
|
9
|
Clinical outcomes with biventricular versus right ventricular pacing in patients with atrioventricular conduction defects. Heart Fail Rev 2018; 23:897-906. [PMID: 29637393 DOI: 10.1007/s10741-018-9699-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There have been increasing concerns about the unexpected effects of right ventricular (RV) pacing. We aimed to systematically evaluate the effect of biventricular (BiV) versus RV pacing on clinical events in patients with impaired AV conduction. We searched PubMed, EMBASE, and Cochrane Library for studies comparing BiV pacing with RV pacing in patients with AV block, through April 2017. We selected randomized controlled trials (RCTs) reporting data on mortality, hospitalization for heart failure (HF), and/or 6-min walk distance (6MWD). A total of 12 RCTs were finally included. Pooled analysis suggested that BiV pacing was associated with a significantly reduced all-cause mortality in contrast to RV pacing (risk ratio (RR) = 0.77, 95% confidence interval (CI) 0.62 to 0.95, I2 = 9.6%). BiV pacing, compared with RV pacing, significantly reduced the rate of HF hospitalization (RR = 0.74, 95% CI 0.59 to 0.93, I2 = 10.1%). Sensitivity analyses by excluding studies with AV nodal ablation showed that BiV pacing still had a lower mortality and non-significant reduced HF hospitalization. Patients in BiV and RV pacing mode had a similar 6WMD at follow-up (mean difference = 4.99 m, 95% CI - 11.34 to 21.33 m, I2 = 0%). Meta-regression analysis showed that the effect size of all-cause mortality or HF hospitalization was not significantly associated with mean LVEF value at baseline. In patients with impaired AV conduction that need frequent ventricular pacing, BiV pacing was associated with reduced mortality and hospitalization for HF, compared with traditional RV pacing mode.
Collapse
|
10
|
Gould J, Sieniewicz B, Porter B, Sidhu B, Rinaldi CA. Chronic Right Ventricular Pacing in the Heart Failure Population. Curr Heart Fail Rep 2018; 15:61-69. [PMID: 29435789 PMCID: PMC5857555 DOI: 10.1007/s11897-018-0376-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose of Review We review the trials that have demonstrated potentially harmful effects from right ventricular (RV) apical pacing as well as reviewing the evidence of alternative RV pacing sites and cardiac resynchronization therapy (CRT) for patients who have heart failure and atrioventricular (AV) block. Recent Findings The role of CRT in patients with AV block and impaired left ventricular function remains an important consideration. The BLOCK HF trial demonstrated better outcomes with CRT pacing over RV pacing in patients with left ventricular systolic dysfunction (LVSD) and AV block who were expected to have a high RV pacing burden, but failed to demonstrate a mortality benefit. Summary CRT seems to have a beneficial effect on left ventricular reverse remodeling, systolic function, and clinical outcomes in patients with New York Heart Association (NYHA) functional class I–III heart failure, moderate to severe LVSD, and AV block compared to RV pacing. However, it is less clear whether there is a similar benefit from CRT in patients with a high percentage of RV pacing who have normal or mild LVSD in the treatment of AV block.
Collapse
Affiliation(s)
- Justin Gould
- King's College London, London, UK. .,Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Benjamin Sieniewicz
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bradley Porter
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Baldeep Sidhu
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Stams TRG, Dunnink A, van Everdingen WM, Beekman HDM, van der Nagel R, Kok B, Bierhuizen MFA, Cramer MJ, Meine M, Vos MA. Deleterious acute and chronic effects of bradycardic right ventricular apex pacing: consequences for arrhythmic outcome. Basic Res Cardiol 2017. [DOI: 10.1007/s00395-017-0636-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Beck H, Curtis AB. Right Ventricular Versus Biventricular Pacing for Heart Failure and Atrioventricular Block. Curr Heart Fail Rep 2016; 13:230-236. [DOI: 10.1007/s11897-016-0299-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
13
|
Stockburger M, Defaye P, Boveda S, Stancak B, Lazarus A, Sipötz J, Nardi S, Rolando M, Moreno J. Safety and efficiency of ventricular pacing prevention with an AAI-DDD changeover mode in patients with sinus node disease or atrioventricular block: impact on battery longevity-a sub-study of the ANSWER trial. Europace 2015; 18:739-46. [PMID: 26612882 PMCID: PMC5841592 DOI: 10.1093/europace/euv358] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/29/2015] [Indexed: 11/13/2022] Open
Abstract
Aims This ANSWER (EvaluAtioN of the SafeR mode in patients With a dual chambER pacemaker indication) sub-study assesses safety and effectiveness of SafeR™ and the impact of ventricular pacing (VP) prevention on anticipated device longevity and replacement rate. Methods and results Patients implanted for atrioventricular block (AVB, n = 310) or sinus node dysfunction (SND, n = 336) were randomly assigned to SafeR (n = 314) or DDD (n = 318) and followed for 36 months. Safety, median VP, estimated device longevity (mean difference, 95% confidence interval [CI]), and anticipated replacement rates were analysed by pacing mode and implant indication. No difference in mortality, syncope, or mode intolerance was observed between randomization groups regardless of the indication. Ventricular pacing on SafeR vs. DDD was 11.5 vs. 93.6% in the overall population (P < 0.001), 89.2 vs. 83.8% in permanent AVB (P = 0.944), 53.5 vs. 98.2% in intermittent AVB (P < 0.001), and 2.2 vs. 84.7% in SND (P < 0.001). Anticipated median device longevity increased on SafeR by 14 [Q1 10; Q3 17] months [10; 17] (P < 0.001) in the overall population, 9 months [−5; 22] (P = 0.193) in permanent AVB, 14 months [8; 19] (P < 0.001) in intermittent AVB, and 14 months [9; 19] (P < 0.001) in SND. In intermittent AVB and SND, prolonged estimated battery longevity translated into the prevention of one anticipated replacement in at least 23% of patients. Conclusion SafeR was effective in reducing VP in intermittent AVB and in SND. No effect was observed in permanent AVB. No safety issue was observed. Ventricular pacing reduction by SafeR translated into relevant estimated prolongation of device longevity and anticipated reduction of required replacements.
Collapse
Affiliation(s)
- Martin Stockburger
- Department of Cardiology and Angiology, Charité University Hospital, Berlin, Germany Department of Cardiology, Havelland Kliniken Nauen, Ketziner Strasse 21, 14641 Nauen, Germany
| | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, Grenoble, France
| | - Serge Boveda
- Arrhythmia Unit, Clinique Pasteur, Toulouse, France
| | - Branislav Stancak
- Arrhythmia Department, Hospital of Eastern Slovakia, Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Arnaud Lazarus
- InParys, A. Paré Private Hospital, Neuilly sur Seine, France
| | | | | | - Mara Rolando
- Sorin Group International SA, Lausanne, Switzerland
| | - Javier Moreno
- Arrhythmia Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain Arrhythmia Department, Hospital Ramón y Cajal, Madrid, Spain
| |
Collapse
|
14
|
Honing in on optimal ventricular pacing sites: an argument for his bundle pacing. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:372. [PMID: 25778424 DOI: 10.1007/s11936-015-0372-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OPINION STATEMENT Frequent ventricular pacing is often or completely unavoidable in patients with high-grade or complete heart block. Over time, patients with high-burden RV pacing are at risk for developing symptomatic cardiomyopathy due to pacing-induced ventricular dyssynchrony. Growing awareness of this concern has generated interest in alternative pacing sites like the septum and outflow tract, the thinking being that these sites will more closely mimic His-Purkinje-mediated ventricular activation. Numerous studies have met with mixed results likely due to the fact that-to quote Marvin Gaye-there ain't nothing like the real thing. Herein lies the advantage of His bundle pacing (HBP), as it is the only pacing modality capable of physiological ventricular activation. HBP has been demonstrated to be safe and reliable in various forms of AV block with minimal drawbacks, namely modestly higher pacing thresholds when compared with other RV sites. Additionally, HBP is a truly physiologic alternative to biventricular pacing to effect cardiac resynchronization therapy (CRT), a concept supported by small observational and prospective studies. In our view, His bundle pacing should be considered in nearly all patients requiring ventricular pacing.
Collapse
|
15
|
Papadopoulou E, Kaladaridou A, Mattheou J, Pamboucas C, Hatzidou S, Antoniou A, Toumanidis S. Effect of pacing mode and pacing site on torsional and strain parameters and on coronary flow. J Am Soc Echocardiogr 2014; 28:347-54. [PMID: 25456534 DOI: 10.1016/j.echo.2014.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Right ventricular apical pacing may induce detrimental effects on left ventricular function and coronary flow. In this study, the effects of pacing site and mode on cardiac mechanics and coronary blood flow were evaluated. METHODS This prospective study included 25 patients who received dual-chamber pacemakers with the ventricular lead placed in the right ventricular apex and presented in sinus rhythm (SR) at their regularly scheduled visits at the pacemaker clinic. Patients underwent complete transthoracic echocardiographic examinations while in SR, followed by noninvasive Doppler assessment of coronary flow in the left anterior descending coronary artery (LAD) and speckle-tracking echocardiography of short-axis planes in SR, atrial pacing (AAI-P), atrioventricular (dual-chamber) pacing (DDD-P), and ventricular pacing (VVI-P). RESULTS Rotation of the base was significantly decreased with VVI-P compared with AAI-P. Left ventricular twist decreased significantly with DDD-P compared with AAI-P. Circumferential strain of the base significantly decreased with DDD-P and VVI-P compared with SR. The velocity-time integral of diastolic flow in the LAD decreased significantly with DDD-P compared with SR (10.7 ± 2.2 vs 10.2 ± 2.2 vs 8.9 ± 1.6 vs 8.7 ± 2.6 cm in SR and with AAI-P, DDD-P, and VVI-P, respectively, P = .003). Basal rotation and time from onset of the QRS complex to peak basal rotation as a percentage of systole were independently associated with the velocity-time integral of diastolic flow in the LAD during SR and the three pacing modes. CONCLUSIONS Acute right ventricular apical pacing showed a detrimental effect on left ventricular twist and basal mechanics, with the latter being independently associated with decreased LAD diastolic flow velocity parameters.
Collapse
Affiliation(s)
- Elektra Papadopoulou
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece.
| | - Anna Kaladaridou
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - John Mattheou
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Constantinos Pamboucas
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Sophia Hatzidou
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Anna Antoniou
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Savvas Toumanidis
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece
| |
Collapse
|
16
|
Muto C, Calvi V, Botto GL, Pecora D, Ciaramitaro G, Valsecchi S, Malacrida M, Maglia G. Is there a right place to pace the right ventricle? Evaluation of apical and septal positions in a pacemaker population: Study protocol for a prospective intervention-control trial. Contemp Clin Trials 2014; 39:320-6. [DOI: 10.1016/j.cct.2014.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
|
17
|
Akerström F, Pachón M, Puchol A, Jiménez-López J, Segovia D, Rodríguez-Padial L, Arias MA. Chronic right ventricular apical pacing: adverse effects and current therapeutic strategies to minimize them. Int J Cardiol 2014; 173:351-60. [PMID: 24721486 DOI: 10.1016/j.ijcard.2014.03.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023]
Abstract
The permanent cardiac pacemaker is the only effective therapy for patients with symptomatic bradycardia and hundreds of millions are implanted worldwide every year. Despite its undisputed clinical benefits, the last two decades have drawn much attention to the negative effects associated with long-term pacing of the right ventricle (RV). Experimental and clinical studies have shown that RV pacing produces ventricular dyssynchrony, similar to that of left bundle branch block, with consequent detrimental effects on cardiac structure and function, with adverse clinical outcomes such as atrial fibrillation, heart failure and death. Although clinical evidence largely comes from subanalyses of pacemaker and implantable cardiac defibrillator studies, there is strong evidence that patients with reduced left ventricular function are at high risk of suffering from the detrimental effects of long-term RV pacing. Biventricular pacing in cardiac resynchronization therapy devices can prevent ventricular dyssynchrony and has emerged as an attractive option in this patient group with promising results and more clinical studies underway. Moreover, there is evidence that specific pacemaker algorithms that minimize RV pacing can reduce the negative effects of RV stimulation on cardiac function and may also prevent clinical deterioration. The extent of the long-term clinical effects of RV pacing in patients with normal ventricular function and how to prevent this are less clear and subject to future investigation.
Collapse
Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Marta Pachón
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Jesús Jiménez-López
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Diana Segovia
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Luis Rodríguez-Padial
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
| |
Collapse
|
18
|
Development of mitral and tricuspid regurgitation in right ventricular apex versus right ventricular outflow tract pacing. J Interv Card Electrophysiol 2014; 40:81-6. [DOI: 10.1007/s10840-014-9878-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
|
19
|
Stockburger M, Gómez-Doblas JJ, Lamas G, Alzueta J, Fernández-Lozano I, Cobo E, Wiegand U, de la Concha JF, Navarro X, Navarro-López F, de Teresa E. Preventing ventricular dysfunction in pacemaker patients without advanced heart failure: results from a multicentre international randomized trial (PREVENT-HF). Eur J Heart Fail 2014; 13:633-41. [DOI: 10.1093/eurjhf/hfr041] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martin Stockburger
- Charité - Universitaetsmedizin Berlin, Experimental and Clinical Research Center (ECRC) Campus Berlin-Buch & Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie; Campus Mitte, Charitéplatz 1, 10117; Berlin Germany
| | - Juan José Gómez-Doblas
- Hospital Clínico Virgen de la Victoria; Campus Universitario Teatinos; 29010 Málaga Spain
| | - Gervasio Lamas
- Division of Cardiology; Mount Sinai Medical Center, Columbia University; FL 33140 USA
| | - Javier Alzueta
- Hospital Clínico Virgen de la Victoria; Campus Universitario Teatinos; 29010 Málaga Spain
| | | | - Erik Cobo
- Universidad Politécnica de Catalunya; C/ Pau Gargallo, 5 08028 Barcelona Spain
| | - Uwe Wiegand
- Universitaetsklinikum Schleswig-Holstein; Campus Luebeck, Ratzeburger Allee 160 23538 Luebeck Germany
| | | | - Xavier Navarro
- Medtronic Ibérica, S.A., C/ María de Portugal, 11; Madrid Spain
| | - Francisco Navarro-López
- Hospital Clínic i Provincial de Barcelona, Universidad de Barcelona; Villaroel 170 Barcelona Spain
| | - Eduardo de Teresa
- Hospital Clínico Virgen de la Victoria; Campus Universitario Teatinos; 29010 Málaga Spain
| |
Collapse
|
20
|
|
21
|
Chen YL, Su MC, Liu WH, Wang CC, Lin MC, Chen MC. Influence and predicting variables of obstructive sleep apnea on cardiac function and remodeling in patients without congestive heart failure. J Clin Sleep Med 2014; 10:57-64. [PMID: 24426821 DOI: 10.5664/jcsm.3360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVE Obstructive sleep apnea syndrome (OSAS) has been considered to be an important predisposing factor for cardiovascular disease. This study aims to investigate the impact of OSAS on cardiac function and remodeling in patients without congestive heart failure. METHODS A total of 79 patients with sleep disordered breathing, preserved systolic function, and normal pro-brain natriuretic peptide level were enrolled. Sixty-five patients were classified to have moderate to severe OSAS (apnea-hypopnea index [AHI] ≥ 15/h), while the other 14 patients with mild or no OSAS (AHI < 15/h) served as control subjects. Baseline clinical and polysomnographic variables as well as tissue Doppler imaging and three-dimensional echocardiographic parameters were obtained. RESULTS The body mass index, neck circumference, Epworth Sleepiness Scale, desaturation index, arousal index, and snoring index were significantly higher in patients with moderate to severe OSAS than those without (p < 0.05). The left atrial size, mitral A-wave velocity, and left ventricular end-diastolic volume were significantly larger, while E/A ratio was lower in patients with moderate to severe OSAS than those without (p < 0.05). Notably, AHI in REM sleep was significantly correlated with the aortic root size, E/A ratio, left ventricular volume, and stroke volume. In addition, the area under the receiver operator characteristic curve for AHI in REM sleep ≥ 32.3/h was 0.647 (95% CI [0.525, 0.769]) in predicting the development of left ventricular diastolic dysfunction. AHI in REM sleep ≥ 32.3/h was the only independent variant in predicting diastolic dysfunction after adjusting the variables including age, gender, hypertension, and body mass index. CONCLUSIONS Patients with moderate to severe OSAS tend to have cardiac dysfunction revealed by echocardiography. High AHI in REM sleep is significantly associated with cardiovascular remodeling and ventricular diastolic dysfunction, and may be a potential variable to predict cardiac dysfunction.
Collapse
Affiliation(s)
- Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Hao Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
22
|
Stockburger M, de Teresa E, Lamas G, Desaga M, Koenig C, Habedank D, Cobo E, Navarro X, Wiegand U. Exercise capacity and N-terminal pro-brain natriuretic peptide levels with biventricular vs. right ventricular pacing for atrioventricular block: results from the PREVENT-HF German Substudy. Europace 2013; 16:63-70. [PMID: 23861381 DOI: 10.1093/europace/eut217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Previous studies showed unfavourable effects of right ventricular (RV) pacing. Ventricular pacing (VP), however, is required in many patients with atrioventricular (AV) block. The PREVENT-HF study explored left ventricular (LV) remodelling during RV vs. biventricular (BIV) pacing in AV block without advanced heart failure. The pre-specified PREVENT-HF German Substudy examined exercise capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP). METHODS AND RESULTS Patients with expected VP ≥80% were randomized to RV or BIV pacing. Endpoints were peak oxygen uptake (pVO2), oxygen uptake at the anaerobic threshold (VO2AT), ventilatory efficiency (VE/VCO2), and logNT-proBNP. Considering crossover, intention to treat (ITT), and on-treatment (OT) analyses of covariance (ANCOVA) were performed. For exercise testing 44 (RV: 25, BIV: 19), and for NT-proBNP 53 patients (RV: 29, BIV: 24) were included. The ITT analysis revealed significant differences in pVO2 [ANCOVA effect 2.83 mL/kg/min, confidence interval (CI) 0.83-4.91, P = 0.007], VO2AT (ANCOVA effect 2.14 mL/min/k, CI 0.14-4.15, P = 0.03), and VE/VCO2 (ANCOVA effect -5.46, CI -10.79 to -0.13, P = 0.04) favouring BIV randomization. The significant advantage in pVO2 persisted in OT analysis, while VO2AT and VE/VCO2 showed trends favouring BIV pacing. LogNT-proBNP did not differ between groups. (ITT: ANCOVA effect 0.008, CI -0.40 to +0.41, P = 0.97; OT: ANCOVA effect -0.03, CI -0.44 to 0.30, P = 0.90). CONCLUSION Our study suggests that BIV pacing produces better exercise capacity over 1 year compared with RV pacing in patients without advanced heart failure and AV block. In contrast, we observed no significant changes of NT-proBNP. Larger trials will allow appraising the clinical usefulness of BIV pacing in AV block. ClinicalTrials.gov Identifier: NCT00170326.
Collapse
Affiliation(s)
- Martin Stockburger
- Charité - Universitaetsmedizin Berlin, Experimental and Clinical Research Center (ECRC), Lindenberger Weg 80, 13125 Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Zhang YY, Wu DY, Fu NK, Lu FM, Xu J. Neuroendocrine and haemodynamic changes in single-lead atrial pacing and dual-chamber pacing modes. J Int Med Res 2013; 41:1057-66. [PMID: 23816931 DOI: 10.1177/0300060513489798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Neuroendocrine and haemodynamic changes were compared between single-lead atrial (AAI) or dual-chamber (DDD) pacing modes in patients with sick sinus syndrome, in a crossover study. METHODS Inpatients scheduled for their first pacemaker implantation were screened for the following inclusion criteria: sick sinus syndrome; intact atrioventricular conduction; normal QRS interval. All study patients were implanted with a dual-chamber pacemaker, programmed for AAI or DDD pacing mode. Patients were allocated randomly to AAI followed by DDD pacing or to DDD followed by AAI pacing, each mode being applied for 72 h. Echocardiographic, electrocardiographic and neuroendocrine parameters were tested at the end of each pacing mode. RESULTS From 152 inpatients screened for inclusion, 28 were selected for treatment. Plasma levels of atrial natriuretic peptide (ANP), endothelin, aldosterone and angiotension II were significantly lower, and aortic flow velocity-time integral was significantly higher, in AAI mode than in DDD mode. Aortic pre-ejection interval, interventricular mechanical delay and QRS duration were significantly higher in DDD than in AAI mode. CONCLUSIONS In patients with sick sinus syndrome, DDD pacing mode can induce neuroendocrine system activation, and left ventricular dysfunction and dyssynchrony. These findings discourage the routine use of DDD pacing in patients with sick sinus syndrome.
Collapse
Affiliation(s)
- Ying-ying Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | | | | | | | | |
Collapse
|
24
|
Kleijn SA, Aly MF, Knol DL, Terwee CB, Jansma EP, Abd El-Hady YA, Kandil HI, Sorour KA, van Rossum AC, Kamp O. A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13:763-775. [DOI: 10.1093/ehjci/jes041] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
|
25
|
The role of pacing-induced dyssynchrony in left ventricular remodeling associated with long-term right ventricular pacing for atrioventricular block. J Electrocardiol 2012; 45:357-360. [DOI: 10.1016/j.jelectrocard.2012.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 11/15/2022]
|
26
|
Kırış A, Karaman K, Kırış G, Şahin M, Durmuş İ, Kaplan Ş, Örem A, Kutlu M, Ayar A. Left Ventricular Dyssynchrony and Its Effects on Cardiac Function in Patients with Newly Diagnosed Hypertension. Echocardiography 2012; 29:914-22. [DOI: 10.1111/j.1540-8175.2012.01727.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
27
|
Straka F, Pirk J, Pindak M, Marek T, Schornik D, Cihak R, Skibova J. A Pilot Study of Systolic Dyssynchrony Index by Real Time Three-Dimensional Echocardiography and Doppler Tissue Imaging Parameters Predicting the Hemodynamic Response to Biventricular Pacing in the Early Postoperative Period after Cardiac Surgery. Echocardiography 2012; 29:827-39. [DOI: 10.1111/j.1540-8175.2012.01694.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
28
|
Wang H, Shuraih M, Ahmad M. Real Time Three-Dimensional Echocardiography in Assessment of Left Ventricular Dyssynchrony and Cardiac Resynchronization Therapy. Echocardiography 2012; 29:192-9. [DOI: 10.1111/j.1540-8175.2011.01622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
29
|
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]
|
30
|
STRAKA F, PIRK J, PINĎÁK M, SKALSKÝ I, VANČURA V, ČIHÁK R, MAREK T, LUPÍNEK P, SCHORNÍK D, MAŠÍN J, ZEMAN M, ŠKROBÁKOVÁ J, DORAZILOVÁ Z, SKIBOVÁ J. Biventricular Pacing in the Early Postoperative Period After Cardiac Surgery. Physiol Res 2011; 60:877-85. [PMID: 21995901 DOI: 10.33549/physiolres.932060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiac resynchronization therapy is not commonly used in the early postoperative period in patients undergoing cardiac surgery who have left ventricular (LV) dysfunction and a history of heart failure. We performed a prospective randomized clinical trial to compare atrial synchronous right ventricular (DDD RV) and biventricular (DDD BIV) pacing within 72 hours after cardiac surgery in patients with an EF ≤35 %, a QRS interval longer than 120 msec and who had LV dyssynchrony detected by real-time three-dimensional echocardiography (RT3DE). Epicardial pacing was provided by a modified Medtronic INSYNC III pacemaker. An LV epicardial pacing lead was implanted on the latest activated segment of the LV based on RT3DE. The study included 18 patients with ischemic heart disease, with or without valvular heart disease (14 men, 4 women, average age 71 years). Patients undergoing DDD BIV pacing had a statistically significant greater CO and CI (CO 6.7±1.8 l/min, CI 3.4±0.7 l/min/m²) than patients undergoing DDD RV pacing (CO 5.5±1.4 l/min, CI 2.8±0.7 l/min/m²), p<0.001. DDD BIV pacing in the early postoperative period after cardiac surgery corrects LV dyssynchrony and has better hemodynamic results than DDD RV pacing.
Collapse
Affiliation(s)
- F. STRAKA
- Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Henrard V, Ducharme A, Khairy P, Gisbert A, Roy D, Levesque S, Talajic M, Thibault B, Racine N, White M, Guerra PG, Tardif JC. Cardiac remodeling with rhythm versus rate control strategies for atrial fibrillation in patients with heart failure: insights from the AF-CHF echocardiographic sub-study. Int J Cardiol 2011; 165:430-6. [PMID: 21917326 DOI: 10.1016/j.ijcard.2011.08.077] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/16/2011] [Accepted: 08/22/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with heart failure and atrial fibrillation, the AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial did not demonstrate the superiority of rhythm control (RhyC) over a rate control (RaC) strategy on cardiovascular mortality. Nevertheless, deleterious hemodynamic effects of atrial fibrillation can lead to further decrease in left ventricular (LV) function and progression of symptoms. This echocardiographic sub-study was designed to compare the effects of the two treatment strategies on LV ejection fraction (LVEF), chamber volumes and dimensions, valvular regurgitation and functional status. METHODS AND RESULTS A total of 59 patients (29 RhyC, 30 RaC) aged 67±8 years (14% women), enrolled in the AF-CHF trial at the Montreal Heart Institute underwent standardized echocardiograms at baseline and at 12 months. Mean LVEF at baseline was severely depressed (RhyC: 27.0±4.9% and RaC: 27.6±7.4%, p=0.73), and improved to a similar degree in both groups (RhyC: +8.0±10.4% and RaC: +4.5±10.6, both p<0.05; p=0.19 for RhyC versus RaC). Other echocardiographic parameters, such as LV end-systolic volume index and degree of mitral and tricuspid regurgitation, remained unchanged. New York Heart Association functional class and distance walked in 6 min improved significantly in both groups (RhyC: +48.9±78.7 m and RaC: +47.2±96.7 m, both p≤0.01), with no difference between RhyC and RaC strategies. CONCLUSIONS Improvements in LVEF and functional status are observed after 12 months in patients with heart failure and atrial fibrillation, regardless of whether rate or rhythm control strategies are used.
Collapse
Affiliation(s)
- Valérie Henrard
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Alhous MHA, Small GR, Hannah A, Hillis GS, Broadhurst P. Impact of temporary right ventricular pacing from different sites on echocardiographic indices of cardiac function. Europace 2011; 13:1738-46. [DOI: 10.1093/europace/eur207] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
33
|
Ji L, Hu W, Yao J, Yu J, Chen C, Yong Y, Zhou L, Xu D. Acute Mechanical Effect of Right Ventricular Pacing at Different Sites Using Velocity Vector Imaging. Echocardiography 2010; 27:1219-27. [DOI: 10.1111/j.1540-8175.2010.01221.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
34
|
Yamano T, Kubo T, Takarada S, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Kitabata H, Hirata K, Tanaka A, Imanishi T, Akasaka T. Advantage of Right Ventricular Outflow Tract Pacing on Cardiac Function and Coronary Circulation in Comparison with Right Ventricular Apex Pacing. J Am Soc Echocardiogr 2010; 23:1177-82. [DOI: 10.1016/j.echo.2010.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Indexed: 11/28/2022]
|
35
|
WOLBER THOMAS, HAEGELI LAURENT, HUERLIMANN DAVID, BRUNCKHORST CORINNA, LÜSCHER THOMASF, DURU FIRAT. Altered Left Ventricular Contraction Pattern during Right Ventricular Pacing: Assessment Using Real-Time Three-Dimensional Echocardiography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:76-81. [DOI: 10.1111/j.1540-8159.2010.02908.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
36
|
Moya-Mur JL, Oliva-De Anquin E, Centella-Hernández T, Ruiz-Leira S, Megías-Sáez A, Tomás-Zarlenga JP, Hernández-Madrid A, García-Galloway E, Moro C. Selección del mejor lugar de estimulación tras cirugía cardiaca evaluando la asincronía con strain tras diferentes estimulaciones. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70248-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
37
|
Moya-Mur JL, Oliva-De Anquin E, Centella-Hernández T, Ruiz-Leira S, Megías-Sáez A, Tomás-Zarlenga JP, Hernández-Madrid A, García-Galloway E, Moro C. Selecting the best site for pacing leads after cardiac surgery by evaluating the asynchrony of myocardial deformation observed with different pacing sites. Rev Esp Cardiol 2010; 63:1162-70. [PMID: 20875356 DOI: 10.1016/s1885-5857(10)70230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES After cardiac surgery, temporary pacing leads are routinely implanted in the right ventricle (RV). The objective was to investigate the effect of different ventricular pacing locations on cardiac synchrony (by evaluating myocardial deformation, or strain) and efficiency in patients undergoing cardiac surgery. METHODS Interventricular asynchrony (i.e. the difference in the time of onset of deformation between right and left ventricles; Tε-R/L) and intraventricular asynchrony (i.e. the standard deviation and maximum difference in the time of onset of deformation in six segments of the left ventricle [LV]; Tε-SD and Tε-MD, respectively) were assessed in 19 patients. Doppler echocardiography was used to evaluate these parameters and cardiac output after pacing in the RV and in three different LV segments. RESULTS Pacing in the RV resulted in the greatest increases in asynchrony parameters from baseline: Tε-R/L 59.8 ms (standard deviation [SD] 40.5 ms) vs. 28.23 ms (SD 56.9 ms), P=.002; Tε-SD 53.2 ms (SD 34.4 ms) vs. 36.6 ms (SD 34.9 ms), P=.007; and Tε-MD 135.3 ms (SD 82.9 ms) vs. 90.5 ms (SD 87.4 ms), P=.007. Pacing in the LV resulted in less asynchrony: for anterior LV pacing, Tε-R/L was 17.2 ms (SD 53.8 ms), Tε-SD was 35.8 ms (SD 17.9 ms), and Tε-MD was 91.3 ms (SD 45.2). The change from baseline was not significant. Cardiac output was lower after RV pacing than after anterior LV pacing: 4.36 (SD 1) vs. 4.70 (SD 1); P=.001. CONCLUSIONS Pacing in the LV produced less asynchrony than RV pacing. In addition, anterior LV pacing resulted in a higher cardiac output than RV pacing. These findings suggest that the location normally used for temporary leads after cardiac surgery should be changed.
Collapse
|
38
|
Liu WH, Guo BF, Chen YL, Tsai TH, Fu M, Chua S, Chen MC. Right Ventricular Outflow Tract Pacing Causes Intraventricular Dyssynchrony in Patients With Sick Sinus Syndrome: A Real-Time Three-Dimensional Echocardiographic Study. J Am Soc Echocardiogr 2010; 23:599-607. [DOI: 10.1016/j.echo.2010.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Indexed: 10/19/2022]
|
39
|
ten Cate TJF, Kelder JC, Plokker HWM, Verzijlbergen JF, van Hemel NM. Myocardial perfusion SPECT identifies patients with left bundle branch block patterns at high risk for future coronary events. J Nucl Cardiol 2010; 17:216-24. [PMID: 20033856 DOI: 10.1007/s12350-009-9183-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 12/02/2009] [Indexed: 01/06/2023]
Abstract
BACKGROUND The value of myocardial perfusion SPECT (MPS) for patients with left bundle branch block (LBBB) or right ventricular apical (RVA) pacing seems reduced. The prognosis of patients with only abnormal activation related perfusion defects (AARD) due to LBBB or RVA-pacing is similar to those with a normal MPS. We assessed the prognostic value of MPS in patients with LBBB or RVA pacing. METHODS Patients with LBBB or RVA pacing referred for vasodilator stress MPS between April 2002 and January 2006 were analyzed. Group 1 are patients with normal MPS and MPS with AARD. Group 2 are patients with an MPS with a perfusion defect extending outside the AARD area. Events were cardiac death, acute myocardial infarction and coronary revascularization. RESULTS In Group 1 (101 patients) 12 events and in Group 2 (96 patients) 45 events occurred during a mean follow-up of 2.6 +/- 1.5 years. The prognosis of Group 2 was significantly worse (49%) compared with Group 1 (91%). The annual cardiac death rate was 0.7%/year in Group 1 and 6.4%/year in Group 2 (P < .001). The prognosis of patients with LBBB was not different from those with RVA pacing. CONCLUSION Group 2 had a significantly worse cardiac prognosis compared to Group 1. The annual cardiac death rate of <1% in Group 1 warrants a watchful waiting strategy, whereas the cardiac death rate in Group 2 warrants aggressive invasive coronary strategies.
Collapse
Affiliation(s)
- Tim J F ten Cate
- Department of Nuclear Medicine, Sint Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | | | | | | | | |
Collapse
|
40
|
McEvoy JW. Biventricular pacing. N Engl J Med 2010; 362:956-7; author reply 958-9. [PMID: 20220195 DOI: 10.1056/nejmc0912940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
41
|
Atrial enlargement in symptomatic heart block patients with preserved left ventricular function: possibly related to atrioventricular dyssynchrony. Int J Cardiol 2009; 148:280-4. [PMID: 19942307 DOI: 10.1016/j.ijcard.2009.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 10/25/2009] [Accepted: 11/08/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Right ventricular apical pacing may possibly induce atrial dilatation as a consequence of atrioventricular dyssynchrony. However, atrial enlargement associated with atrioventricular dyssynchrony due to atrioventricular block has never been studied. METHODS This case-control survey involved 90 patients with symptomatic atrioventricular block [29 patients with Mobitz type 2 atrioventricular block, 22 patients with high degree of atrioventricular block and 39 patients with complete atrioventricular block]. The control group comprised 54 age- and sex-matched patients with sick sinus syndrome and intact intrinsic atrioventricular conduction. The M-mode measurements were obtained before implant and the left and right atrial areas were measured by planimetry. RESULTS The peri-implant right atrial area (17.4±3.7 vs. 15.3±3.4 cm2, p=0.002), left atrial area (24.9±4.2 vs. 21.0±3.7 cm2, p<0.001) and left atrial diameter (36.4±5.5 vs. 33.3±4.8 mm, p=0.001) were significantly greater in atrioventricular block patients than in sick sinus syndrome patients. The two groups had similar left ventricular ejection fraction. The right atrial area (p=0.01) and left atrial area (p=0.006) remained significantly greater in atrioventricular block patients than in sick sinus syndrome patients after adjustments for age, gender, body surface area, left ventricular dimension and left ventricular ejection fraction in multiple logistic regression analysis. CONCLUSIONS Atrial enlargement occurs in patients with symptomatic atrioventricular block. This phenomenon is possibly related to atrioventricular dyssynchrony.
Collapse
|
42
|
Ro PS, Chan DP, Ackley T, Fenstermaker B, Hayes J, Cua CL. Tissue doppler changes in pediatric complete heart block patients who are chronically paced. CONGENIT HEART DIS 2009; 4:448-53. [PMID: 19925538 DOI: 10.1111/j.1747-0803.2009.00342.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pediatric patients with complete heart block (CHB) often require pacemaker therapy. Adult studies have shown chronic right ventricular pacemaker therapy may be associated with decreased echocardiographic parameters and increased brain natriuretic peptide (BNP) values. The goal of this study was to determine if there are echocardiographic or BNP changes in a pediatric population that is chronically paced. METHODS Patients were recruited if they had CHB and had a pacemaker. Patients were excluded if they had congenital structural heart disease. Standard two-dimensional echocardiograms, including tissue Doppler imaging (TDI), were performed. BNP values were obtained. Nonparametric Spearman's rank correlation was used for analysis. Rho < or = 0.05 was considered significant. RESULTS Eighteen patients (16.4 +/- 7.3 years) with CHB were studied. Age at implant was 8.6 +/- 6.6 years and length of pacing was 7.8 +/- 6.6 years. Pacing mode was VDD, DDD, DDDR, or VVIR. All patients were ventricularly paced >95% of the time. Ejection fraction was 58.5 +/- 7.5%. All BNP values were <40 pg/mL. There was no correlation between ejection fraction or BNP level with the length of pacing years. Pacing years significantly correlated with mitral and tricuspid E/A ratios (rho =-0.56, -0.56, respectively). Pacing years also correlated with right ventricular and interventricular TDI a wave (rho = 0.61 and 0.68, respectively). Furthermore, pacing years correlated with right ventricular TDI e/a ratio (rho =-0.58). CONCLUSIONS Ejection fraction and BNP levels were not sensitive parameters in evaluating pediatric patients who are chronically paced. Subtle diastolic changes, especially of the right ventricle, were detected by TDI.
Collapse
Affiliation(s)
- Pamela S Ro
- Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43205-2696, USA
| | | | | | | | | | | |
Collapse
|
43
|
Fang F, Chan JYS, Yip GWK, Xie JM, Zhang Q, Fung JWH, Lam YY, Yu CM. Prevalence and determinants of left ventricular systolic dyssynchrony in patients with normal ejection fraction received right ventricular apical pacing: a real-time three-dimensional echocardiographic study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:109-18. [DOI: 10.1093/ejechocard/jep171] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
44
|
Wang YC, Lin YH, Liu YB, Lee JK, Chen YS, Lee HH, Lin LC, Ho YL, Chen WJ. The immediate effects of pacemaker-related electric remodelling on left ventricular function in patients with sick sinus syndrome. Europace 2009; 11:1660-5. [DOI: 10.1093/europace/eup322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
45
|
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.
Collapse
Affiliation(s)
- Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | |
Collapse
|
46
|
Maraschiello MA, Redfearn DP, Baranchuk AM, Simpson CS. Right ventricular apical lead position is associated with prolonged signal-averaged P-wave duration. J Electrocardiol 2009; 42:561-5. [PMID: 19733859 DOI: 10.1016/j.jelectrocard.2009.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Indexed: 10/20/2022]
Abstract
AIM The study aimed to determine if right ventricular apical pacing is associated with adverse change in atrial substrate compared with right ventricular septal pacing. METHODS Patients with septal leads and dual-chamber devices with more than 3 months of follow-up and 70% or higher cumulative percentage of ventricular pacing were compared with a matched group of apically implanted leads with a cumulative percentage ventricular pacing of 70% or higher. Device parameters were recorded, and high-resolution recordings were obtained for signal-averaged P-wave (SAPW) analysis. Previously obtained SAPW recordings taken from 49 healthy patients and 73 patients with paroxysmal atrial fibrillation were used as negative and positive controls, respectively. RESULTS Ten patients with septal leads (mean age, 71.9 +/- 12.1 years; mean months implanted, 10.5 +/- 3.2 months) and 9 patients with apical leads (mean age, 71.9 +/- 5.7 years; mean months implanted, 11.4 +/- 6.4 months) were enrolled. The SAPW duration was longer in the apical cohort compared with the septal cohort (144.8 +/- 6.9 and 133.0 +/- 5.5 milliseconds, respectively; P = .001), whereas there was no significant difference between septal and normal cohorts (133.0 +/- 5.5 and 129.3 +/- 7.1 milliseconds, respectively; P = .08). CONCLUSIONS Apical pacing is associated with prolonged P-wave duration relative to septal pacing and controls: this may manifest as increased risk of atrial tachycardias and presents a potentially novel benefit of septal pacing.
Collapse
Affiliation(s)
- Mark A Maraschiello
- Arrhythmia Service, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | | | | | | |
Collapse
|
47
|
The use of real-time three-dimensional echocardiography for the quantification of left ventricular volumes and function. Curr Opin Cardiol 2009; 24:402-9. [DOI: 10.1097/hco.0b013e32832cbb8a] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Lim P, Mitchell-Heggs L, Buakhamsri A, Thomas JD, Grimm RA. Impact of left ventricular size on tissue Doppler and longitudinal strain by speckle tracking for assessing wall motion and mechanical dyssynchrony in candidates for cardiac resynchronization therapy. J Am Soc Echocardiogr 2009; 22:695-701. [PMID: 19501329 DOI: 10.1016/j.echo.2009.04.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Myocardial dysfunction and left ventricular (LV) geometry deformation may reduce the accuracy of tissue Doppler imaging (TDI) in assessing myocardial contractility. METHODS In 92 patients with heart failure who underwent cardiac resynchronization therapy (CRT), we assessed the impact of LV end-diastolic volume on the accuracy of peak longitudinal velocity (TDI) and strain (epsilon(L) by speckle tracking) to assess regional wall motion and LV dyssynchrony. RESULTS Peak-epsilon correlated to normal (-13% +/- 6%, n = 259), hypokinetic (-10% +/- 5%, n = 347), and akinetic (-7% +/- 5%, n = 498, P < .0001) wall motion independent of LV size. In contrast, velocity failed to distinguish normal from dysfunctional segments in patients with severe LV dilatation (end-diastolic volume > 250 mL). The 12 standard deviation of time to peak systolic velocity and the opposing septal-lateral wall delay by strain and TDI failed to predict response to CRT, whereas the 12 segment standard deviation of time to peak epsilon correlated to end-systolic volume reduction (r = -0.39, P < .001). CONCLUSION Accuracy of TDI in assessing LV wall regional motion is limited in severely dilated ventricles and probably affects LV dyssynchrony measurement.
Collapse
Affiliation(s)
- Pascal Lim
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | | | | | | |
Collapse
|
49
|
Matsuoka K, Nishino M, Kato H, Egami Y, Shutta R, Yamaguchi H, Tanaka K, Tanouchi J, Yamada Y. Right Ventricular Apical Pacing Impairs Left Ventricular Twist as Well as Synchrony: Acute Effects of Right Ventricular Apical Pacing. J Am Soc Echocardiogr 2009; 22:914-9; quiz 970-1. [DOI: 10.1016/j.echo.2009.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Indexed: 11/27/2022]
|
50
|
Stockburger M, Trautmann F, Nitardy A, Just-Teetzmann M, Schade S, Celebi O, Krebs A, Dietz R. Pacemaker-based analysis of atrioventricular conduction and atrial tachyarrhythmias in patients with primary sinus node dysfunction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:604-13. [PMID: 19422581 DOI: 10.1111/j.1540-8159.2009.02333.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most patients with symptomatic sinus node disease (SND) receive DDDR pacemakers (PM) in order to cover SND and atrioventricular (AV) block from the outset. But the concern about adverse effects of right ventricular pacing (RVP) is increasing. So far, data on the incidence of AV block in SND are based on clinical events. The study undertakes to assess and appraise AV block and atrial tachyarrhythmias (AT) from memory and electrograms of a dual-chamber PM set to an AAIR-DDDR switch mode (AAISafeR). METHODS A dual-chamber PM incorporating the AAISafeR mode was implanted in 58 patients (70 +/- 10 years, 28 males) with SND, but without AV block >I. AV block and AT episodes were retrieved from the PM memory and validated from electrograms. AV block episodes were classified potentially relevant while comprising AV block III or AV block I/II during exercise. RESULTS The patients experienced a median of 90 (interquartile range 7-1,084) commutations. Possibly relevant AV block occurred in 32 patients (55%). Validation revealed high-quality PM-based categorization. The RVP prevalence was 0% (0-16%). The median AT prevalence was 0.03 (0-26) min/day. RVP was the only multivariate predictor of AT (P = 0.001). CONCLUSIONS Potentially relevant AV block occurs frequently in patients with SND. Nonetheless, the RVP prevalence is kept low through the AAISafeR mode. The protection of SND patients with demand-actuated ventricular pacing appears reasonable. The AT prevalence is low in SND patients treated by the AAISafeR mode. Even low RVP proportions appear to favor AT. Prospective evaluation is needed.
Collapse
Affiliation(s)
- Martin Stockburger
- Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|