1
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Koniari I, Gerakaris A, Kounis N, Velissaris D, Rao A, Ainslie M, Adlan A, Plotas P, Ikonomidis I, Mplani V, Hung MY, de Gregorio C, Kolettis T, Gupta D. Outcomes of Atrioventricular Node Ablation and Pacing in Patients with Heart Failure and Atrial Fibrillation: From Cardiac Resynchronization Therapy to His Bundle Pacing. J Cardiovasc Dev Dis 2023; 10:272. [PMID: 37504528 PMCID: PMC10380427 DOI: 10.3390/jcdd10070272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Objective: To review the relevant literature on the use of atrioventricular node ablation and pacing in patients with heart failure and atrial fibrillation. Methods: APubMed/MEDLINE and SCOPUS search was performed in order to assess the clinical outcomes of atrioventricular node ablation and pacemaker implantation, as well as the complications that may occur. Results: Several clinical trials, observational analyses and meta-analyses have shown that the "pace and ablate" strategy not only improves symptoms but also can enhance cardiac performance in patients with heart failure and atrial fibrillation. Although this procedure is effective and safe, some complications may occur including worsening of heart failure, permanent fibrillation, arrhythmias and sudden death. Regarding pacemaker implantation, cardiac resynchronization therapy is shown to be the optimal choice compared to right ventricle apical pacing. His bundle pacing is a promising alternative to cardiac resynchronization therapy and has shown beneficial effects, while left bundle branch pacing is an innovative modality. Conclusions: Atrioventricular node ablation and pacemaker implantation is shown to have beneficial effects on clinical outcomes of patients with atrial fibrillation ± heart failure who do not respond or are intolerant to medical treatment. Cardiac resynchronization therapy is the treatment of choice and His bundle pacing seems to be an effective alternative way of pacing in these patients.
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Affiliation(s)
- Ioanna Koniari
- Department of Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK; (I.K.); (A.R.); (D.G.)
| | - Andreas Gerakaris
- Department of Internal Medicine, University Hospital of Patras, 26500 Patras, Greece; (A.G.); (D.V.)
| | - Nicholas Kounis
- Department of Medicine, Division of Cardiology, University Hospital of Patras, 26500 Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, University Hospital of Patras, 26500 Patras, Greece; (A.G.); (D.V.)
| | - Archana Rao
- Department of Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK; (I.K.); (A.R.); (D.G.)
| | - Mark Ainslie
- Department of Cardiology, Manchester Heart Institute, University Hospital of Manchester, Manchester M23 9LT, UK; (M.A.); (A.A.)
| | - Ahmed Adlan
- Department of Cardiology, Manchester Heart Institute, University Hospital of Manchester, Manchester M23 9LT, UK; (M.A.); (A.A.)
| | - Panagiotis Plotas
- Laboratory Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, 26500 Patras, Greece;
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology, “Attikon” Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece;
| | - Virginia Mplani
- Department of Intensive Care Unit, Patras University Hospital, 26500 Patras, Greece;
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City 23561, Taiwan;
- Taipei Heart Institute, Taipei Medical University, Taipei City 110301, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110301, Taiwan
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, 98122 Messina, Italy;
| | - Theofilos Kolettis
- Cardiovascular Research Institute, Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece;
| | - Dhiraj Gupta
- Department of Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK; (I.K.); (A.R.); (D.G.)
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2
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Yu Z, Chen R, Su Y, Chen X, Qin S, Li M, Han F, Ge J. Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis. BMC Cardiovasc Disord 2017; 17:221. [PMID: 28800733 PMCID: PMC5553603 DOI: 10.1186/s12872-017-0649-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Long-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of cardiac function. HBRP including direct His bundle pacing and para-His bundle pacing was regarded as a novel physiological pacing pattern to avoid devastating cardiac function. This synthetic study was conducted to integratively and quantitatively evaluate the efficacy of His bundle related pacing (HBRP) in comparison with conventional right ventricular pacing (RVP). Methods Published studies on comparison of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), New York Heart Association (NYHA) class, inter-ventricular asynchrony, and QRS duration, etc. between HBRP and RVP were collected and for meta-analysis. Results HBRP showed higher LVEF (WMD = 3.9%, 95% CI: 1.6% – 6.1%), lower NYHA class (WMD = −0.5, 95% CI: -0.7 – -0.3), WMD of LVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml), less inter-ventricular asynchrony (WMD = −13.2 ms, 95% CI: -16.4 – -10.0 ms), and shorter QRS duration for long-term (WMD = −36.9 ms, 95% CI: -40.0 – -33.8 ms), however, no significant difference of ventricular volume (WMDLVEDV = −2.4 ml, 95% CI: -5.0 – 0.2 ml; WMDLVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml) compared to RVP. Conclusions The efficacy of HBRP was firstly verified by meta-analysis to date. Compared with RVP, HBRP markedly preserve LVEF, NYHA class, and QRS duration. However, it seemed to have less effect on ventricular volume. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0649-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ziqing Yu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ruizhen Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Fei Han
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
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3
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Lopes C, Pereira T, Barra S. Cardiac resynchronization therapy in patients with atrial fibrillation: a meta-analysis. Rev Port Cardiol 2016; 33:717-25. [PMID: 25457476 DOI: 10.1016/j.repc.2014.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 02/25/2014] [Accepted: 05/17/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To combine the results of the best scientific evidence in order to compare the effects of cardiac resynchronization therapy (CRT) in heart failure patients with atrial fibrillation (AF) and in sinus rhythm (SR) and to determine the effect of atrioventricular nodal ablation in AF patients. METHODS The electronic databases PubMed, B-On and Cochrane CENTRAL were searched, and manual searches were performed, for randomized controlled trials and cohort studies up to November 2012. The endpoints analyzed were all-cause and cardiovascular mortality and response to CRT. RESULTS We included 19 studies involving 5324 patients: 1399 in AF and 3925 in SR. All-cause mortality was more likely in patients with AF compared to patients in SR (OR = 1.69; 95% CI: 1.20–2.37; p = 0.002). There were no statistically significant differences in cardiovascular mortality (OR = 1.36; 95% CI: 0.92–2.01; p = 0.12). AF was associated with an increased likelihood of lack of response to CRT (OR = 1.41; 95% CI: 1.15–1.73; p = 0.001). Among subjects with AF, ablation of the atrioventricular node was associated with a reduction in all-cause mortality (OR = 0.42; 95% CI: 0.22–0.80; p = 0.008), cardiovascular death (OR = 0.39; 95% CI: 0.20–0.75; p = 0.005) and the number of non-responders to CRT (OR = 0.30; 95% CI: 0.10–0.90; p = 0.03). CONCLUSIONS The presence of AF is associated with increased likelihood of all-cause death and non-response to CRT, compared to patients in SR. However, many patients with AF benefit from CRT. Atrioventricular nodal ablation appears to increase the benefits of CRT in patients with AF.
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Affiliation(s)
- Cláudia Lopes
- Escola Superior de Tecnologia das Saúde de Coimbra, Departamento de Cardiopneumologia, Coimbra, Portugal.
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4
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Das A, Kahali D. Physiological cardiac pacing: Current status. Indian Heart J 2016; 68:552-8. [PMID: 27543481 PMCID: PMC4990729 DOI: 10.1016/j.ihj.2016.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/09/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022] Open
Abstract
Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics. Direct His bundle pacing and Para-Hisian pacing are the most physiological ventricular pacing sites. But, this is technically difficult. Ventricular septal pacing compared to apical pacing results in a shorter electrical activation delay and consequently less mechanical dyssynchrony. But, the study results are heterogeneous. Selective site atria pacing (atrial septal) is useful for patients with atrial conduction disorders in prevention of AF.
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Affiliation(s)
- Asit Das
- RMO-cum-Clinical Tutor, Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, India.
| | - Dhiman Kahali
- Senior Interventional Cardiologist, B. M. Birla Heart Research Centre, Kolkata, India
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5
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Lopes C, Pereira T, Barra S. Cardiac resynchronization therapy in patients with atrial fibrillation: A meta-analysis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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6
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Ortega MC, Morejón AEG, Ricardo GS. Left ventricular synchrony and function in pediatric patients with definitive pacemakers. Arq Bras Cardiol 2013; 101:410-7. [PMID: 24061683 PMCID: PMC4081164 DOI: 10.5935/abc.20130189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 11/19/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chronic right ventricular pacing (RVP) induces a dyssynchronous contraction pattern,producing interventricular and intraventricular asynchrony. Many studies have shown the relationship of RVP with impaired left ventricular (LV) form and function. OBJECTIVE The aim of this study was to evaluate LV synchrony and function in pediatric patients receiving RVP in comparison with those receiving LV pacing (LVP). METHODS LV systolic and diastolic function and synchrony were evaluated in 80 pediatric patients with either nonsurgical or postsurgical complete atrioventricular block, with pacing from either the RV endocardium (n = 40) or the LV epicardium (n = 40). Echocardiographic data obtained before pacemaker implantation, immediately after it, and at the end of a mean follow-up of 6.8 years were analyzed. RESULTS LV diastolic function did not change in any patient during follow-up. LV systolic function was preserved in patients with LVP. However, in children with RVP the shortening fraction and ejection fraction decreased from medians of 41% ± 2.6% and 70% ± 6.9% before implantation to 32% ± 4.2% and 64% ± 2.5% (p < 0.0001 and p < 0.0001), respectively, at final follow-up. Interventricular mechanical delay was significantly larger with RVP (66 ± 13 ms) than with LVP (20 ± 8 ms). Similarly, the following parameters were significantly different in the two groups: LV mechanical delay (RVP: 69 ± 6 ms, LVP: 30 ± 11 ms, p < 0.0001); septal to lateral wall motion delay (RVP: 75 ± 19 ms, LVP: 42 ± 10 ms, p < 0.0001); and, septal to posterior wall motion delay (RVP: 127 ± 33 ms, LVP: 58 ± 17 ms, p < 0.0001). CONCLUSION Compared with RV endocardium, LV epicardium is an optimal site for pacing to preserve cardiac synchrony and function.
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Affiliation(s)
- Michel Cabrera Ortega
- Departamento de Arritmia e Estimulação Cardíaca - Cardiocentro
Pediátrico ¨William Soler¨, Havana, Cuba
- Mailing Address: Michel Cabrera Ortega, 100 y Perla, Altahabana, Boyeros
10800, Havana, Cuba. E-mail:
| | | | - Giselle Serrano Ricardo
- Havana, Cuba; Departamento de Ecocardiografia - Cardiocentro Pediátrico
¨William Soler¨, Havana, Cuba
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7
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Abstract
In the last few years, there has been a major shift in the treatment of atrial fibrillation (AF) in the setting of hear failure (HF), from rhythm to ventricular rate control in most patients with both conditions. In this article, the authors focus on ventricular rate control and discuss the indications; the optimal ventricular rate-control target, including detailed results of the Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison Between Lenient versus Strict Rate Control II (RACE II) study; and the pharmacologic and nonpharmacologic options to control the ventricular rate during AF in the setting of HF.
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Affiliation(s)
- Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Hanzeplein 1, PO Box 30.001, Groningen 9700 RB, The Netherlands
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8
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Xie JM, Fang F, Zhang Q, Sanderson JE, Chan JYS, Lam YY, Yu CM. Acute effects of right ventricular apical pacing on left atrial remodeling and function. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:856-62. [PMID: 22540397 DOI: 10.1111/j.1540-8159.2012.03403.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The acute effects of right ventricular apical (RVA) pacing on left atrial (LA) function in patients with normal ejection fraction are not clear. METHODS A total of 94 patients (age 68.1 ± 11.1 years, 26 men) with implanted RVA-based dual-chamber pacemakers were recruited into this study. Patients who were pacemaker-dependent, in persistent atrial fibrillation or left ventricular ejection fraction <45% were excluded. Echocardiography (iE33, Philips, Andover, MA, USA) was performed during intrinsic ventricular conduction (V-sense) and RVA pacing (V-pace) with 15 minutes between switching modes. The total maximal LA volume (LAV(max)), preatrial contraction volume (LAV(pre)), and minimal volume (LAV(min)) were assessed by area-length method. Peak systolic, early diastolic, and peak late diastolic (atrial contractile) velocity (Sm-la, Em-la, and Am-la) and strain (ɛs-la, ɛe-la, and ɛa-la) were measured by color-coded tissue Doppler imaging (TDI) in four mid-LA walls at apical four- and two-chamber views. RESULTS During V-pace, LA volumes increased significantly compared with V-sense (LAV(max): 52.0 ± 18.8 vs 55.2 ± 21.1 mL, P = 0.005; LAV(pre): 39.8 ± 16.4 vs 41.3 ± 16.6 mL, P = 0.014; LAV(min): 27.4 ± 14.0 vs 29.1 ± 15.1 mL, P = 0.001). TDI parameters showed significant reduction in Sm-la and Em-la. Furthermore, ɛs-la, ɛe-la, and ɛa-la decreased significantly, especially in patients with preexisting diastolic dysfunction (all P < 0.01). CONCLUSIONS RVA pacing acutely induced LA enlargement and impaired atrial contractility. Patients with preexisting diastolic dysfunction may be more vulnerable to develop LA dysfunction and remodeling after acute RVA pacing.
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Affiliation(s)
- Jun-Min Xie
- Institute of Vascular Medicine and Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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9
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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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10
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van Geldorp IE, Vanagt WY, Prinzen FW, Delhaas T. Chronic ventricular pacing in children: toward prevention of pacing-induced heart disease. Heart Fail Rev 2011; 16:305-14. [PMID: 21107685 PMCID: PMC3074059 DOI: 10.1007/s10741-010-9207-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In children with congenital or acquired complete atrioventricular (AV) block, ventricular pacing is indicated to increase heart rate. Ventricular pacing is highly beneficial in these patients, but an important side effect is that it induces abnormal electrical activation patterns. Traditionally, ventricular pacemaker leads are positioned at the right ventricle (RV). The dyssynchronous pattern of ventricular activation due to RV pacing is associated with an acute and chronic impairment of left ventricular (LV) function, structural remodeling of the LV, and increased risk of heart failure. Since the degree of pacing-induced dyssynchrony varies between the different pacing sites, ‘optimal-site pacing’ should aim at the prevention of mechanical dyssynchrony. Especially in children, generally paced from a very early age and having a perspective of life-long pacing, the preservation of cardiac function during chronic ventricular pacing should take high priority. In the perspective of the (patho)physiology of ventricular pacing and the importance of the sequence of activation, this paper provides an overview of the current knowledge regarding possible alternative sites for chronic ventricular pacing. Furthermore, clinical implications and practical concerns of the various pacing sites are discussed. The review concludes with recommendations for optimal-site pacing in children.
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Affiliation(s)
- Irene E van Geldorp
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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11
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Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation 2011; 123:e269-367. [PMID: 21382897 DOI: 10.1161/cir.0b013e318214876d] [Citation(s) in RCA: 595] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol 2011; 57:e101-98. [PMID: 21392637 DOI: 10.1016/j.jacc.2010.09.013] [Citation(s) in RCA: 642] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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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]
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14
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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.
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Intramural Dyssynchrony from Acute Right Ventricular Apical Pacing in Human Subjects with Normal Left Ventricular Function. J Cardiovasc Transl Res 2010; 3:321-9. [DOI: 10.1007/s12265-010-9176-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 03/01/2010] [Indexed: 01/23/2023]
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16
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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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17
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Blom NA. Is the left ventricle the preferred pacing site in all children with atrioventricular block? Europace 2009; 11:1134-5. [DOI: 10.1093/europace/eup226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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FRIEDBERG MARKK, DUBIN ANNEM, VAN HARE GEORGEF, McDANIEL GEORGEM, NIKSCH ALISA, ROSENTHAL DAVIDN. Pacing-Induced Electromechanical Ventricular Dyssynchrony Does Not Acutely Influence Right Ventricular Function and Global Hemodynamics in Children with Normal Hearts. J Cardiovasc Electrophysiol 2009; 20:539-44. [DOI: 10.1111/j.1540-8167.2008.01354.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Maisenbacher HW, Estrada AH, Prosek R, Shih AC, Vangilder JM. Evaluation of the effects of transvenous pacing site on left ventricular function and synchrony in healthy anesthetized dogs. Am J Vet Res 2009; 70:455-63. [PMID: 19335100 DOI: 10.2460/ajvr.70.4.455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE-To compare the acute effects of cardiac pacing from various transvenous pacing sites on left ventricular (LV) function and synchrony in clinically normal dogs. ANIMALS-10 healthy adult mixed-breed dogs. PROCEDURES-Dogs were anesthetized, and dual-chamber transvenous biventricular pacing systems were implanted. Dogs were paced in single-chamber mode from the right atrial appendage (RAA) alone and in dual-chamber mode from the right ventricular apex (RVA), from the left ventricular free wall (LVFW), and simultaneously from the RVA and LVFW (BiV). Standard ECG and echocardiographic measurements, cardiac output measured with the lithium dilution method (LiDCO), and tissue Doppler-derived measurements of LV synchrony were obtained during each of the pacing configurations. RESULTS-Placement of the biventricular pacing systems was possible in 8 of the 10 dogs. The QRS duration was significantly different among all pacing sites, and the order of increasing duration was RAA, BiV, LVFW, and RVA. Pacing sites did not differ with respect to fractional shortening; however, pacing from the RVA resulted in a significantly lower ejection fraction than pacing from all other sites. During RVA and LVFW pacing, LiDCO was significantly lower than that at other sites; there was no significant difference between RAA and BiV pacing with respect to LiDCO. Although the degree of dyssynchrony was significantly lower during pacing from the RAA versus other ventricular pacing sites, it was not significantly different among sites. CONCLUSIONS AND CLINICAL RELEVANCE-Ventricular activation by RAA pacing provided the best LV function and synchrony. Pacing from the RVA worsened LV function, and although pacing from the LVFW improved it, BiV pacing may provide additional improvement.
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Affiliation(s)
- Herbert W Maisenbacher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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20
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Sanaa I, Franceschi F, Prevot S, Bastard E, Deharo JC. Right ventricular apex pacing: is it obsolete? Arch Cardiovasc Dis 2009; 102:135-41. [PMID: 19303581 DOI: 10.1016/j.acvd.2008.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 10/14/2008] [Accepted: 10/14/2008] [Indexed: 12/30/2022]
Abstract
Clinical trials in patients with pacemakers for sinus node dysfunction or atrioventricular block have highlighted the fact that desynchronization of ventricular contraction induced by right ventricular apical pacing is associated with long-term morbidity and mortality. These clinical data confirm pathophysiological results indicating that right ventricular apical pacing causes abnormal ventricular contraction, reduces pump function and leads to myocardial hypertrophy and ultrastructural abnormalities. In this manuscript, we discuss the clinical evidence for the adverse and beneficial effects of various right ventricular pacing sites, left ventricular pacing sites and biventricular pacing. We also propose a decisional algorithm for pacing modalities, based on atrioventricular conduction, left ventricular function and expected lifespan.
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Affiliation(s)
- Islem Sanaa
- Unité de rythmologie, service de cardiologie, hôpital La Timone Adultes, 9e étage, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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21
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Chronic left ventricular pacing preserves left ventricular function in children. Pediatr Cardiol 2009; 30:125-32. [PMID: 18704551 DOI: 10.1007/s00246-008-9284-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/07/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
Chronic right ventricular (RV) pacing can induce structural and functional cardiac deterioration. Because animal studies showed a benefit of left ventricular (LV) over RV pacing, this study compared the effects of chronic RV and LV pacing in children. Retrospectively, echocardiographic data were evaluated from 18 healthy children (control subjects) and from children undergoing chronic epicardial RV pacing (7 RVP) or LV pacing (7 LVP). Assessment included LV end-diastolic wall thickness (LVEDWT) and end-systolic wall thickness (LVESWT) as well as LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD). The shortening fraction and eccentricity index (LV diameter/2xLV wall thickness) were calculated as measures of LV function and eccentricity, respectively. Duration of QRS and septal posterior wall motion delay (SPWMD) were used as measures of electrical and mechanical dyssynchrony, respectively. A p value less than 0.05 determined significance. As the findings showed, LVEDD, LVESD, LVEDWT, and LVESWT were not significantly different between the groups. The shortening fraction was significantly lower in the RVP (21.7%+/-6.0%) than in the LVP (32.2%+/-5.2%) or control (29.3%+/-4.3%) children. The systolic LV eccentricity index was significantly larger in the RVP (1.8+/-0.2) than in the LVP (1.4+/-0.1) or control (1.4+/-0.2) children. The SPWMD was significantly larger in the RVP (338+/-20 ms) than in the LVP (-16+/-14 ms) or control (-5+/-35 ms) group, whereas QRS duration was similarly longer in the RVP (157+/-10 ms) and LVP (158+/-22 ms) groups compared than in the control group (69+/-7 ms). The authors conclude that LV function in children is preserved by chronic pacing at the LV lateral wall.
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22
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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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23
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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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24
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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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25
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Affiliation(s)
- Michael O. Sweeney
- From the Brigham and Women’s Hospital (M.O.S.), Harvard Medical School, Boston, Mass; and the Department of Physiology (F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Frits W. Prinzen
- From the Brigham and Women’s Hospital (M.O.S.), Harvard Medical School, Boston, Mass; and the Department of Physiology (F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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26
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VAN GELDER BERRYM, MEIJER ALBERT, BRACKE FRANKA. Stimulation Rate and the Optimal Interventricular Interval during Cardiac Resynchronization Therapy in Patients with Chronic Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:569-74. [DOI: 10.1111/j.1540-8159.2008.01042.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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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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28
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Basu Ray I, Fendelander L, Singh JP. Cardiac resynchronization therapy and its potential proarrhythmic effect. Clin Cardiol 2008; 30:498-502. [PMID: 17823906 PMCID: PMC6653034 DOI: 10.1002/clc.17] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) has become an established adjunctive treatment to optimal pharmacologic therapy in patients with advanced chronic heart failure (CHF), diminished left ventricular (LV) function and intraventricular conduction delay. Although CRT has been shown to improve ventricular hemodynamics, quality of life and exercise capacity, there is some evidence that it may rarely potentiate ventricular arrhythmias. As CRT is considered for an expanded population of CHF patients, and left-sided pacing is considered as an option for pacemaker-indicated patients (potentially without defibrillator backup), the effect of these pacing modalities on the incidence of ventricular tachyarrhythmia must be systematically studied and mechanistically understood. Strategies to prospectively predict the proarrhythmic potential of LV epicardial pacing need to be developed, and therapy accordingly individualized. This review attempts to summarize the current information on proarrhythmia in resynchronization therapy.
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Affiliation(s)
- Indranill Basu Ray
- Harvard Thorndike Electrophysiology Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Guidant Corporation, St. Paul, Minnesota; Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lahn Fendelander
- Harvard Thorndike Electrophysiology Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Guidant Corporation, St. Paul, Minnesota; Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagmeet P. Singh
- Harvard Thorndike Electrophysiology Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Guidant Corporation, St. Paul, Minnesota; Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Rao RK, Kumar UN, Schafer J, Viloria E, De Lurgio D, Foster E. Reduced Ventricular Volumes and Improved Systolic Function With Cardiac Resynchronization Therapy. Circulation 2007; 115:2136-44. [PMID: 17420340 DOI: 10.1161/circulationaha.106.634444] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cardiac resynchronization therapy has emerged as an important therapy for advanced systolic heart failure. Among available cardiac resynchronization therapy pacing modes that restore ventricular synchrony, it is uncertain whether simultaneous biventricular (BiV), sequential BiV, or left ventricular (LV) pacing is superior. The Device Evaluation of CONTAK RENEWAL 2 and EASYTRAK 2: Assessment of Safety and Effectiveness in Heart Failure (DECREASE-HF) trial is the first randomized trial comparing these 3 cardiac resynchronization therapy modalities.
Methods and Results—
The DECREASE-HF Trial is a multicenter trial in which 306 patients with New York Heart Association class III or IV heart failure, an LV ejection fraction ≤35%, and a QRS duration ≥150 ms were randomized to simultaneous BiV, sequential BiV, or LV pacing. LV volumes and systolic and diastolic function were assessed with echocardiography at baseline, 3 months, and 6 months. All groups had a significant reduction in LV end-systolic and end-diastolic dimensions (
P
<0.001). The simultaneous BiV pacing group had the greatest reduction in LV end-systolic dimension (
P
=0.007). Stroke volume (
P
<0.001) and LV ejection fraction (
P
<0.001) improved in all groups with no difference across groups.
Conclusions—
Compared with LV pacing, simultaneous BiV pacing was associated with a trend toward greater improvement in LV size. There is little difference between simultaneous BiV pacing and sequential BiV pacing as programmed in this trial.
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Affiliation(s)
- Rajni K Rao
- University of California, San Francisco, Department of Medicine, Division of Cardiology, 505 Parnassus Ave, San Francisco, CA 94143-0214, USA
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30
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Varadarajan P, Pai RG, Pohost GM. A role for cardiac resynchronization therapy in heart failure patients with atrial fibrillation. Curr Cardiol Rep 2006; 8:387-8. [PMID: 17059787 DOI: 10.1007/s11886-006-0092-0] [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: 11/26/2022]
Affiliation(s)
- Padmini Varadarajan
- Division of Cardiology Medicine, University of Southern California/Keck School of Medicine, 1510 San Pablo Street, #322,Los Angeles, CA 90033, USA
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Lieberman R, Padeletti L, Schreuder J, Jackson K, Michelucci A, Colella A, Eastman W, Valsecchi S, Hettrick DA. Ventricular Pacing Lead Location Alters Systemic Hemodynamics and Left Ventricular Function in Patients With and Without Reduced Ejection Fraction. J Am Coll Cardiol 2006; 48:1634-41. [PMID: 17045900 DOI: 10.1016/j.jacc.2006.04.099] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Revised: 04/17/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We compared left ventricular (LV) systolic and diastolic function during right ventricular (RV), LV, and biventricular (BiV) pacing in patients with narrow QRS duration with and without LV dysfunction. BACKGROUND The optimal RV pacing lead location for patients with a standard indication for ventricular pacing remains controversial. METHODS Left ventricular pressure and volume data were determined via conductance catheter during electrophysiology study in 31 patients divided into groups with ejection fraction (EF) > or =40% (n = 17) or EF <40% (n = 14). QRS duration was 91 +/- 18 versus 106 +/- 25 ms, respectively (p = NS). Hemodynamic data were recorded during atrial and dual chamber pacing from the RV apex, RV free wall, RV septum, LV free wall, and BiV. RESULTS In patients with EF > or =40%, RV pacing at 1 or more sites, but not LV free wall or BiV pacing, significantly (p < 0.05) impaired cardiac output (CO), stroke work (SW), EF, and LV relaxation compared with atrial overdrive pacing. Right ventricular pacing also impaired hemodynamics and LV function in patients with EF <40%. However, LV and BiV pacing increased CO, SW, EF, and LV +dP/dt(MAX) in patients with LV dysfunction. Left ventricular and BiV pacing enhanced an index of global LV cycle efficiency in patients with depressed EF. The detrimental hemodynamic effects of RV pacing were attenuated by selecting the optimal RV pacing site. CONCLUSIONS Right ventricular pacing worsens LV function in patients with and without LV dysfunction unless the RV pacing site is optimized. Left ventricular and BiV pacing preserve LV function in patients with EF >40% and improve function in patients with EF <40% despite no clinical indication for BiV pacing.
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Affiliation(s)
- Randy Lieberman
- Department of Cardiology, Harper University Hospital, Detroit, Michigan 48201, USA.
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Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e257-354. [PMID: 16908781 DOI: 10.1161/circulationaha.106.177292] [Citation(s) in RCA: 1381] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Raffa S, Fantoni C, Restauri L, Auricchio A. Right heart failure due to loss of right ventricular capture in a patient with atrioventricular junction ablation and biventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 28:1127-30. [PMID: 16221274 DOI: 10.1111/j.1540-8159.2005.00229.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe the case of a patient with atrioventricular (AV) junction ablation and chronic biventricular pacing in which intermittent dysfunction of the right ventricular (RV) lead resulted in left ventricular (LV) stimulation alone and onset of severe right heart failure. Restoration of biventricular pacing by increasing device output and then performing lead revision resolved the issue. This case provides evidence that LV pacing alone in patients with AV junction ablation may lead to severe right heart failure, most likely as a result of iatrogenic mechanical dyssynchrony within the RV. Thus, probably this pacing mode should be avoided in pacemaker-dependent patients with heart failure.
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Affiliation(s)
- Santi Raffa
- Division of Cardiology, University Hospital of Magdeburg, Germany
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Sweeney MO, Prinzen FW. A New Paradigm for Physiologic Ventricular Pacing. J Am Coll Cardiol 2006; 47:282-8. [PMID: 16412848 DOI: 10.1016/j.jacc.2005.09.029] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 08/20/2005] [Accepted: 09/08/2005] [Indexed: 11/18/2022]
Abstract
Clinical trials in patients with pacemakers for sinus node dysfunction or atrioventricular block (AVB) and implantable cardioverter-defibrillators provide increasing evidence showing that desynchronization of ventricular electrical activation and contraction, induced by conventional right ventricular apex (RVA) pacing, is a serious threat for long-term cardiac morbidity and mortality. The risk of heart failure is increased even in hearts with initially normal pump function and in case of part-time ventricular pacing. These epidemiologic data fit with knowledge from decades of pathophysiological research, indicating that right ventricular (RV) pacing creates abnormal contraction, reduced pump function, hypertrophy, and ultrastructural abnormalities. This paper presents a new paradigm that aims to tailor ventricular pacing to the individual patient to achieve a way of pacing that is as physiologic as possible. In patients without AVB and no intraventricular conduction abnormalities, ventricular pacing should be avoided as much as possible, using atrial-based pacing. In patients with AVB, alternate single-site RV or left ventricular pacing or biventricular pacing may be superior to RVA pacing. Efforts to optimize the pacing mode or site should be greater in patients with a longer expected duration of pacing, poorer cardiac function, and larger mechanical asynchrony. Awareness of the problem of desynchronization should also lead to more regular monitoring of cardiac pump function and mechanical asynchrony in any patient with ventricular pacing.
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Affiliation(s)
- Michael O Sweeney
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Auricchio A. Cardiac resynchronization therapy: does varying the pacing site or combination of sites improve cardiac function? NATURE CLINICAL PRACTICE. CARDIOVASCULAR MEDICINE 2005; 2:288-9. [PMID: 16265532 DOI: 10.1038/ncpcardio0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2005] [Accepted: 04/06/2005] [Indexed: 05/05/2023]
Affiliation(s)
- Angelo Auricchio
- Cardiac Catheterization Laboratory, University Hospital Magdeburg, Germany.
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Vanagt WY, Verbeek XA, Delhaas T, Gewillig M, Mertens L, Wouters P, Meyns B, Daenen WJ, Prinzen FW. Acute Hemodynamic Benefit of Left Ventricular Apex Pacing in Children. Ann Thorac Surg 2005; 79:932-6. [PMID: 15734407 DOI: 10.1016/j.athoracsur.2004.08.053] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite the fact that pacing at the right ventricular apex acutely and chronically decreases left ventricular contractile function, this pacing site is still conventionally used in adults and children. Because animal studies showed beneficial effects of left ventricular pacing, we compared the hemodynamic performance of left ventricular apex, left ventricular free wall, and right ventricular apex pacing in children. METHODS Studies were performed in 10 children (median age, 2.5 years; range, 2 months to 17 years) undergoing surgery for congenital heart disease with normal systemic left ventricular anatomy and intraventricular conduction. High-fidelity left ventricular and arterial pressure measurements were performed during epicardial right ventricular apex and left ventricular apex and free wall pacing. RESULTS Left ventricular apex pacing increased the maximum rate of rise of left ventricular pressure and pulse pressure significantly relative to right ventricular apex pacing (by 7.7% +/- 7.2% and 7.7% +/- 7.0%, respectively) without changes in end-diastolic left ventricular pressure. Left ventricular free wall pacing did not significantly improve hemodynamics as compared with right ventricular apex pacing. The QRS duration was not different among pacing at the three sites. CONCLUSIONS In this short-term study left ventricular apex pacing is hemodynamically superior to right ventricular apex and left ventricular free wall pacing in children. Therefore, the left ventricular apex appears a favorable pacing site after pediatric cardiac surgery.
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Affiliation(s)
- Ward Y Vanagt
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Brignole M, Gammage M, Puggioni E, Alboni P, Raviele A, Sutton R, Vardas P, Bongiorni MG, Bergfeldt L, Menozzi C, Musso G. Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation. Eur Heart J 2004; 26:712-22. [PMID: 15618036 DOI: 10.1093/eurheartj/ehi069] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS Left ventricular (LV) and biventricular (BiV) pacing are potentially superior to right ventricular (RV) apical pacing in patients undergoing atrioventricular (AV) junction ablation and pacing for permanent atrial fibrillation. METHODS AND RESULTS Prospective randomized, single-blind, 3-month crossover comparison between RV and LV pacing (phase 1) and between RV and BiV pacing (phase 2) performed in 56 patients (70+/-8 years, 34 males) affected by severely symptomatic permanent atrial fibrillation, uncontrolled ventricular rate, or heart failure. Primary endpoints were quality of life and exercise capacity. Compared with RV pacing, the Minnesota Living with Heart Failure Questionnaire (LHFQ) score improved by 2 and 10% with LV and BiV pacing, respectively, the effort dyspnoea item of the Specific Symptom Scale (SSS) changed by 0 and 2%, the Karolinska score by 6 and 14% (P<0.05 for BiV), the New York Heart Association (NYHA) class by 5 and 11% (P<0.05 for BiV), the 6-min walked distance by 12 (+4%) and 4 m (+1%), and the ejection fraction by 5 and 5% (P<0.05 for both). BiV pacing but not LV pacing was slightly better than RV pacing in the subgroup of patients with preserved systolic function and absence of native left bundle branch block. Compared with pre-ablation measures, the Minnesota LHFQ score improved by 37, 39, and 49% during RV, LV, and BiV pacing, respectively, the effort dyspnoea item of the SSS by 25, 25, and 39%, the Karolinska score by 39, 42, and 54%, the NYHA class by 21, 25, and 30%, the 6-min walking distance by 35 (12%), 47 (16%), and 51 m (19%) and the ejection fraction by 5, 10, and 10% (all differences P<0.05). CONCLUSIONS Rhythm regularization achieved with AV-junction ablation improved quality of life and exercise capacity with all modes of pacing. LV and BiV pacing provided modest or no additional favourable effect compared with RV pacing.
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Affiliation(s)
- M Brignole
- Department of Cardiology, Ospedali del Tigullio, Via don Bobbio, 16033 Lavagna, Italy.
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Hay I, Melenovsky V, Fetics BJ, Judge DP, Kramer A, Spinelli J, Reister C, Kass DA, Berger RD. Short-Term Effects of Right-Left Heart Sequential Cardiac Resynchronization in Patients With Heart Failure, Chronic Atrial Fibrillation, and Atrioventricular Nodal Block. Circulation 2004; 110:3404-10. [PMID: 15557370 DOI: 10.1161/01.cir.0000148177.82319.c7] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single-site ventricular pacing in patients with heart failure, atrial fibrillation, and severe atrioventricular (AV) nodal block risks the generation of discoordinate contraction. Whether altering the site of stimulation can offset this detrimental effect and what role sequential right ventricular-left ventricular (RV-LV) stimulation might play in such patients remain unknown. METHODS AND RESULTS Nine subjects with heart failure (ejection fraction, 14% to 30%), atrial fibrillation, and AV block were studied by pressure-volume analysis. Ventricular stimulation was applied to the RV (apex and outflow tract), LV free wall, and biventricular (BiV) at 80 and 120 bpm. BiV improved systolic function more than either site alone (dP/dt(max), 810+/-83, 924+/-98, 983+/-102 mm Hg/s for RV, LV, BiV, respectively; P<0.05), although LV pacing was significantly better than RV pacing. However, only BiV improved diastolic function (isovolumic relaxation) over RV or LV alone. Similar results were obtained for both heart rates. RV pacing site did not alter the BiV effect, and concomitant stimulation of both RV sites did not improve function over each alone. Finally, varying RV-LV delay revealed optimal responses with simultaneous pacing. CONCLUSIONS Simultaneous BiV pacing acutely enhances both systolic and diastolic function over single-site RV or LV pacing in congestive heart failure patients with atrial fibrillation and advanced AV block. Sequential RV-LV stimulation offers minimal benefit on average and should perhaps be considered only in targeted subsets such as nonresponding patients.
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Affiliation(s)
- Ilan Hay
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md, USA
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Vinereanu D, Bleasdale R, Turner M, Frenneaux MP, Fraser AG. Comparison of left ventricular-biventricular pacing on ventricular synchrony, mitral regurgitation, and global left ventricular function in patients with severe chronic heart failure. Am J Cardiol 2004; 94:519-21. [PMID: 15325945 DOI: 10.1016/j.amjcard.2004.04.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 04/22/2004] [Indexed: 10/26/2022]
Abstract
We compared the effects of left ventricular and biventricular pacing in 16 patients (15 men and 1 woman; aged 64 +/- 8 years) with severe heart failure by conventional and tissue Doppler echocardiography. Intraventricular synchrony, regional and global systolic function, diastolic function and filling time, and the severity of secondary mitral regurgitation were similar between left ventricular and biventricular pacing.
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Affiliation(s)
- Dragos Vinereanu
- Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom
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Gammage MD, Marsh AM. Randomized Trials for Selective Site Pacing:. Do We Know Where We Are Going? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:878-82. [PMID: 15189519 DOI: 10.1111/j.1540-8159.2004.00550.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical evidence is accumulating that pacing from traditional right-sided sites (right ventricular apex and right atrial appendage) may be associated with long-term detriment to left ventricular function and promotion of atrial arrhythmias. Large numbers of small studies, some randomized, have addressed the effects of pacing from nontraditional or alternate sites, but the studies have varied in design such that comparison of results is often difficult. Many studies show data from acute studies only, although more recently longer-term data have started to become available; definition and description of pacing site also varies, adding further to the difficulties in comparing data. This article attempts to examine the randomized studies available to date, and to consider how future studies may contribute to our understanding of the effects of pacing from traditional and selected, specific sites on the right side of the heart.
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Affiliation(s)
- Michael D Gammage
- Department of Cardiovascular Medicine, Center for Cardiovascular Sciences, University of Birmingham and University Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
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Vanagt WY, Verbeek XA, Delhaas T, Mertens L, Daenen WJ, Prinzen FW. The Left Ventricular Apex is the Optimal Site for Pediatric Pacing:. Correlation with Animal Experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:837-43. [PMID: 15189513 DOI: 10.1111/j.1540-8159.2004.00544.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pacing at the commonly used right ventricular (RV) apex results in impaired ventricular performance. Previous animal studies indicated that the left ventricular (LV) apex is a superior pacing site. The purpose of this study was to investigate in dogs whether this good performance is associated with a more synchronous electrical activation pattern of the LV and whether the LV apex is also a good pacing site in children. In 11 healthy dogs and 8 children undergoing cardiac surgery, dual chamber pacing was performed at the RV apex, LV apex and LV lateral free wall (LVFW). In dogs, a basket electrode was inserted into the LV to assess pattern and timing of LV endocardial activation. In the children, hemodynamic measurements were performed immediately after recovery from cardiopulmonary bypass. In dogs, LV apex pacing resulted in synchronous activation around the LV circumference whereas RV apex and LVFW pacing resulted in asynchrony of activation between the septum and LVFW. In both canine and children's hearts most hemodynamic variables remained at sinus rhythm level during LV apex pacing, but LVdPdtmax, stroke work (dogs), and pulse pressure (children) were reduced as compared with sinus rhythm during RV apex and LVFW pacing. LV apex pacing results in synchronous activation of the LV and is, in adult dogs and in children, associated with superior hemodynamic performance.
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Affiliation(s)
- Ward Y Vanagt
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Auricchio A. Pacing the left ventricle: does underlying rhythm matter?**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2004; 43:239-40. [PMID: 14736443 DOI: 10.1016/j.jacc.2003.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Angelo Auricchio
- Division of Cardiology, University Hospital, Magdeburg, Germany.
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