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Karpawich PP. Recognizing limitations of echocardiography for paced ventricular function. Heart Rhythm 2024; 21:462-463. [PMID: 38042444 DOI: 10.1016/j.hrthm.2023.11.027] [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] [Received: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Peter P Karpawich
- Section of Cardiac Electrophysiology, The Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Central Michigan University, College of Medicine, Mount Pleasant, Michigan.
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2
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Karpawich PP, Chubb H. Indications for Cardiac Resynchronization Therapy in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:433-445. [PMID: 37865517 DOI: 10.1016/j.ccep.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Heart failure in patients with congenital heart disease (CHD) stems from unique causes compared with the elderly. Patients with CHD face structural abnormalities and malformations present from birth, leading to altered cardiac function and potential complications. In contrast, elderly individuals primarily experience heart failure due to age-related changes and underlying cardiovascular conditions. Cardiac resynchronization therapy (CRT) can benefit patients with CHD, although it presents numerous challenges. The complexities of CHD anatomy and limited access to appropriate venous sites for lead placement make CRT implantation demanding.
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Affiliation(s)
- Peter P Karpawich
- Department of Pediatrics, Central Michigan University College of Medicine, Cardiac Electrophysiology, The Children's Hospital of Michigan, Detroit, MI, USA.
| | - Henry Chubb
- Stanford University School of Medicine, Stanford Medicine Children's Health, Palo Alto, CA, USA; Pediatric Heart Center, 725 Welch Road, Suite 120, MC 5912, Palo Alto, CA 94304, USA
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3
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Inoue N, Ogane T, Hiramatsu T, Morikawa S. Relationship between left-axis deviation and onset of cardiac adverse events in right ventricular pacing. J Electrocardiol 2023; 80:119-124. [PMID: 37327711 DOI: 10.1016/j.jelectrocard.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023]
Abstract
AIMS The electrical axis shows alterations during right ventricular pacing (RVP), including a normal axis and left axis deviation; however, it remains unknown if differences in the electrical axis affect the occurrence of cardiac adverse events. The purpose of this study was to determine whether a left axis deviation increases the incidence of adverse cardiac events compared with a normal axis. METHODS This study analysed 156 patients with RVP. The patients were divided into two groups: those with left axis deviation after RVP (LAD group) and those with a normal axis (NA group). The primary composite outcome was the new-onset of atrial fibrillation (AF) and worsening heart failure (HF). RESULTS The QRS axis of the LAD (n = 77) and NA (n = 79) groups were - 64.5 ± 14.3° and 29.8 ± 36.5°, respectively (P < 0.001). The median follow-up was 1100 days and, regarding primary composite outcomes (hazard ratio, 1.03; 95% confidence interval, 0.64 to 1.65; P = 0.89), 29/77 (37.6%) and 28/79 (35.4%) patients in the LAD and NA groups, respectively, developed AF (hazard ratio, 1.07; 95% confidence interval, 0.64 to 1.81; P = 0.77). Furthermore, 8/77 (10.3%) and 12/79 (15.1%) patients in the LAD and NA groups, respectively, experienced worsening HF (hazard ratio, 0.65; 95% confidence interval, 0.26 to 1.60; P = 0.35). CONCLUSION The risk of cardiac adverse events in patients with RVP (new-onset AF or worsening HF, cardiovascular death, myocardial infarction, and stroke) and overall mortality with LAD is not higher than that with NA.
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Affiliation(s)
- Naoya Inoue
- Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Takashi Ogane
- Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
| | - Takehiro Hiramatsu
- Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shuji Morikawa
- Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Ansalone G, Boriani G, Sassone B, Camastra G, Donal E, Calò L, Casella M, Delarche N, Lozano IF, Biffi M, Boulogne E, Guidotto T, Leclercq C. Biventricular versus left ventricular only stimulation: an echocardiographic substudy of the B-LEFT HF trial. J Cardiovasc Med (Hagerstown) 2023; 24:453-460. [PMID: 37285276 DOI: 10.2459/jcm.0000000000001480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The noninferiority of left ventricular pacing alone (LVp) compared with biventricular pacing (BIV) has not been yet definitely documented. In this study, we reviewed all the original echocardiographic measures of the Biventricular versus Left Univentricular Pacing with ICD Back-up in Heart Failure Patients (B-LEFT HF) trial in order to investigate mechanisms underlying LV remodelling with both pacing modalities. METHODS Patients with New York Heart Association functional class (NYHA) III or IV despite optimal medical therapy, LVEF 35% or less, left ventricular end-diastolic diameter (LVEDD) more than 55 mm, QRS duration at least 130 ms were randomized to BIV or LVp for 6 months. The primary end point was a composite of at least 1 point decrease in NYHA class and at least 5 mm decrease in left ventricular end-systolic diameter (LVESD). An additional end point was a LVp reverse remodelling defined as at least 10% decrease in LVESD. Mitral regurgitation and all echocardiographic measures were reassessed after 6-month follow-up. RESULTS One hundred and forty-three patients were enrolled. Seventy-six patients were in the BIV and 67 were in the LVp group. Left ventricular volumes decreased significantly without difference between groups (P = 0.8447). Similarly, left ventricular diameters decreased significantly in both groups with a significant decrease in LVESD with BIV (P < 0.0001), but not with LVp (P = 0.1383). LVEF improved in both groups without difference (P = 0.8072). Mitral regurgitation did not improve either with BIV, or with LVp. CONCLUSION The echocardiographic sub-analysis of B-LEFT study showed the substantial equivalence of LVp in favouring left ventricular reverse remodelling as compared with BIV.
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Affiliation(s)
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Biagio Sassone
- Department of Cardiology, Ospedale SS.ma Annunziata, Azienda Unità Sanitaria Locale Ferrara, Cento, Italy
| | | | | | | | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, Milan, Italy
| | | | | | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
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5
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Santos H, Figueiredo M, Paula SB, Santos M, Osório P, Portugal G, Valente B, Lousinha A, Silva Cunha P, Oliveira M. Apical or Septal Right Ventricular Location in Patients Receiving Defibrillation Leads: A Systematic Review and Meta-Analysis. Cardiol Rev 2023; Publish Ahead of Print:00045415-990000000-00080. [PMID: 36883833 DOI: 10.1097/crd.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
This study reviews the published data comparing the efficacy and safety of apical and septal right ventricle defibrillator lead positioning at 1-year follow-up. Systemic research on Medline (PubMed), ClinicalTrials.gov, and Embase was performed using the keywords "septal defibrillation," "apical defibrillation," "site defibrillation," and "defibrillation lead placement," including implantable cardioverter-defibrillator and cardiac resynchronization therapy devices. Comparisons between apical and septal position were performed regarding R-wave amplitude, pacing threshold at a pulse width of 0.5 ms, pacing and shock lead impedance, suboptimal lead performance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, readmissions due to heart failure and mortality rates. A total of 5 studies comprising 1438 patients were included in the analysis. Mean age was 64.5 years, 76.9% were male, with a median LVEF of 27.8%, ischemic etiology in 51.1%, and a mean follow-up period of 26.5 months. The apical lead placement was performed in 743 patients and septal lead placement in 690 patients. Comparing the 2 placement sites, no significant differences were found regarding R-wave amplitude, lead impedance, suboptimal lead performance, LVEF, left ventricular end-diastolic diameter, and mortality rate at 1-year follow-up. Pacing threshold values favored septal defibrillator lead placement (P = 0.003), as well as shock impedance (P = 0.009) and readmissions due to heart failure (P = 0.02). Among patients receiving a defibrillator lead, only pacing threshold, shock lead impedance, and readmission due to heart failure showed results favoring septal lead placement. Therefore, generally, the right ventricle lead placement does not appear to be of major importance.
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Affiliation(s)
- Helder Santos
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Margarida Figueiredo
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Sofia B Paula
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Mariana Santos
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Paulo Osório
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Guilherme Portugal
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Bruno Valente
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Ana Lousinha
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Pedro Silva Cunha
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Mário Oliveira
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
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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.
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van Nieuwenhoven FA, Schroen B, Barile L, van Middendorp L, Prinzen FW, Auricchio A. Plasma Extracellular Vesicles as Liquid Biopsy to Unravel the Molecular Mechanisms of Cardiac Reverse Remodeling Following Resynchronization Therapy? J Clin Med 2023; 12:jcm12020665. [PMID: 36675594 PMCID: PMC9862724 DOI: 10.3390/jcm12020665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) has become a valuable addition to the treatment options for heart failure, in particular for patients with disturbances in electrical conduction that lead to regionally different contraction patterns (dyssynchrony). Dyssynchronous hearts show extensive molecular and cellular remodeling, which has primarily been investigated in experimental animals. Evidence showing that at least several miRNAs play a role in this remodeling is increasing. A comparison of results from measurements in plasma and myocardial tissue suggests that plasma levels of miRNAs may reflect the expression of these miRNAs in the heart. Because many miRNAs released in the plasma are included in extracellular vesicles (EVs), which protect them from degradation, measurement of myocardium-derived miRNAs in peripheral blood EVs may open new avenues to investigate and monitor (reverse) remodeling in dyssynchronous and resynchronized hearts of patients.
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Affiliation(s)
- Frans A. van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Blanche Schroen
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lucio Barile
- Laboratory for Cardiovascular Theranostics, Istituto Cardiocentro Ticino, 6900 Lugano, Switzerland
| | - Lars van Middendorp
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence:
| | - Angelo Auricchio
- Department of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
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Ohta Y, Goda A, Daimon A, Manabe E, Masai K, Kishima H, Mine T, Asakura M, Ishihara M. The differences between conventional lead, thin lead, and leadless pacemakers regarding effects on tricuspid regurgitation in the early phase. J Med Ultrason (2001) 2023; 50:51-56. [PMID: 36520249 DOI: 10.1007/s10396-022-01274-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Trans-venous pacemaker leads are associated with worsening of tricuspid regurgitation (TR) after pacemaker implantation (PMI) in some cases. Recently, leadless pacemakers and thin ventricular pacemaker leads without a stylet lumen have become popular. However, the differences in the effects of these leads on TR are unclear. We investigated differences in the changes in TR in the early phase after PMI in patients with conventional leads, thin leads, and leadless pacemakers. METHODS We enrolled 65 patients who underwent PMI (32 males, 79 ± 8 years), including 48 with trans-venous PMI (29 with conventional 6.0-Fr leads and 19 with 4.1-Fr thin leads) and 17 with leadless pacemakers. Transthoracic echocardiography was performed before and 1 month after PMI for assessment of conventional echocardiographic parameters and severity of TR by quantitative assessment. RESULTS Atrial fibrillation was the most frequent indication for PMI in patients with leadless pacemakers (p = 0.015). In the before and 1 month after PMI comparison, left ventricular ejection fraction decreased after PMI only in the conventional lead group (p = 0.022). The TR effective regurgitant orifice area (EROA) decreased post PMI in the leadless (p = 0.002) and thin lead groups (p = 0.001), but not in the conventional lead group (p = 0.596). The change in TR EROA was greater in the leadless and thin lead groups as compared with the conventional lead group (p < 0.05). CONCLUSION The decrease in TR EROA in the early phase after PMI differed according to the type of pacemaker lead. The thin lead might be beneficial for reduction of TR after PMI.
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Affiliation(s)
- Yoshihiro Ohta
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan.
| | - Aika Daimon
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
| | - Eri Manabe
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
| | - Kumiko Masai
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
| | - Hideyuki Kishima
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
| | - Takanao Mine
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
| | - Masanori Asakura
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan
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Stojadinović P, Deshraju A, Wichterle D, Fukunaga M, Peichl P, Kautzner J, Šramko M. The hemodynamic effect of simulated atrial fibrillation on left ventricular function. J Cardiovasc Electrophysiol 2022; 33:2569-2577. [PMID: 36069129 DOI: 10.1111/jce.15669] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common sustained arrhythmia in humans. The onset of the arrhythmia can significantly impair cardiac function. This hemodynamic deterioration has been explained by several mechanisms such as the loss of atrial contraction, shortening of ventricular filling, or heart rhythm irregularity. This study sought to evaluate the relative hemodynamic contribution of each of these components during in vivo simulated human AF. METHODS Twelve patients undergoing catheter ablation for paroxysmal AF were paced simultaneously from the proximal coronary sinus and the His bundle region according to prescribed sequences of irregular R-R intervals with the average rate of 90 and 130 bpm, which were extracted from the database of digital ECG recordings of AF from other patients. The simulated AF was compared to regular atrial pacing with spontaneous atrioventricular conduction and regular simultaneous atrioventricular pacing at the same heart rate. Beat-by-beat left atrial and left ventricular pressures, including LV dP/dT and Tau index were assessed by direct invasive measurement; beat-by-beat stroke volume and cardiac output (index) were assessed by simultaneous pulse-wave doppler intracardiac echocardiography. RESULTS Simulated AF led to significant impairment of left ventricular systolic and diastolic function. Both loss of atrial contraction and heart rate irregularity significantly contributed to hemodynamic impairment. This effect was pronounced with increasing heart rate. CONCLUSION Our findings strengthen the rationale for therapeutic strategies aiming at rhythm control and heart rate regularization in patients with AF.
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Affiliation(s)
- Predrag Stojadinović
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aslesha Deshraju
- Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dan Wichterle
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Masato Fukunaga
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marek Šramko
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.,2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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10
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Ogano M, Tsuboi I, Tanabe J. Cardiac resynchronization therapy for electrical dyssynchrony with a narrow QRS duration and left anterior hemiblock. HeartRhythm Case Rep 2021; 7:829-832. [PMID: 34987969 PMCID: PMC8695277 DOI: 10.1016/j.hrcr.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michio Ogano
- Address reprint requests and correspondence: Dr Michio Ogano, Division of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan.
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11
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Bastos MB, Burkhoff D, Maly J, Daemen J, den Uil CA, Ameloot K, Lenzen M, Mahfoud F, Zijlstra F, Schreuder JJ, Van Mieghem NM. Invasive left ventricle pressure-volume analysis: overview and practical clinical implications. Eur Heart J 2021; 41:1286-1297. [PMID: 31435675 PMCID: PMC7084193 DOI: 10.1093/eurheartj/ehz552] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/22/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022] Open
Abstract
Ventricular pressure–volume (PV) analysis is the reference method for the study of cardiac mechanics. Advances in calibration algorithms and measuring techniques brought new perspectives for its application in different research and clinical settings. Simultaneous PV measurement in the heart chambers offers unique insights into mechanical cardiac efficiency. Beat to beat invasive PV monitoring can be instrumental in the understanding and management of heart failure, valvular heart disease, and mechanical cardiac support. This review focuses on intra cardiac left ventricular PV analysis principles, interpretation of signals, and potential clinical applications. ![]()
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Affiliation(s)
- Marcelo B Bastos
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | | | - Jiri Maly
- Department of Cardiac and Transplant Surgery, IKEM, Prague, Czech Republic
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands.,Department of Intensive Care Medicine, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Koen Ameloot
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Mattie Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Jan J Schreuder
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
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12
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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.
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13
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Kochav JD, Rosenbaum M, Kochav SM, Slater E, Wassercug-Zemer N, Lewis MJ. Effect of Ventricular Pacing on Morbidity in Adults After Fontan Repair. Am J Cardiol 2020; 125:1263-1269. [PMID: 32081367 DOI: 10.1016/j.amjcard.2020.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/12/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022]
Abstract
Implantation of a permanent pacemaker is a negative prognostic marker in patients with Fontan palliation; however, data delineating outcomes in adult patients with pacemaker requirements are lacking. We hypothesize that high ventricular pacing burden is associated with adverse outcomes in adult Fontan patients. We performed a retrospective review comprising adult patients with history of Fontan repair. A high burden of ventricular pacing was defined as ≥40% pacing. Major adverse clinical events (MACE) were defined as all-cause mortality or need for advanced cardiac therapies (ventricular assist device or heart transplant). A total of 145 adult patients with Fontan were studied for a median of 3.1 years. Twenty (14%) patients had implanted pacemakers with ≥40% ventricular pacing. Twelve events occurred in those with ≥40% ventricular pacing (incidence 60.0%) versus 11 in those without (incidence 8.8%). In multivariable analysis, ≥40% ventricular-pacing (odds ratio 12.51, confidence interval [CI] 3.56 to 43.83, p <0.001) was associated with MACE independent of initial Fontan type, New York Heart Association functional class at baseline, or history of atrial tachyarrythmia. In survival analysis, patients with ≥40% ventricular pacing had nearly 8 times the risk of MACE compared with those with a lower ventricular pacing burden (hazard ratio 7.79, 95% CI 2.56 to 23.66, p <0.001), whereas patients with atrial-only or <40% ventricular pacing burden had a trend toward higher hazard of MACE compared with those without permanent pacemaker (hazard ratio 3.38, 95% CI 0.92 to 12.47, p = 0.07) that did not meet statistical significance. These findings suggest that high ventricular pacing burden contributes to poor outcomes in the adult Fontan patients and bear consideration when determining optimal treatment of tachyarrhythmias in this population.
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Affiliation(s)
- Jonathan D Kochav
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marlon Rosenbaum
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M Kochav
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Emily Slater
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Noa Wassercug-Zemer
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Matthew J Lewis
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York.
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Algazzar AS, Elbably MM, Katta AA, Elmeligy N, Elrabbat K, Qutub MA. Merits of Different Ventricular Lead Locations on Left Ventricular Myocardial Strain and Dyssynchrony in Patients with Cardiac Resynchronization Therapy. Cardiology 2019; 145:13-20. [PMID: 31778999 DOI: 10.1159/000503953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The idea behind cardiac resynchronization therapy (CRT) is to pace both ventricles resulting in a synchronized electro-mechanical coupling of the left ventricle (LV), meaning every effort should be made to improve the percentage of CRT responders. OBJECTIVES This study aimed at demonstrating the short-term effect of right ventricular apical (RVA) and mid-septal (RVS) lead locations combined with different LV lead positions on LV myocardial strain, dyssynchrony, and clinical outcomes. METHODS We examined 60 patients with indication for CRT before and after 6 months of implantation for clinical outcome and CRT response (6-min walk test [6MWT], NYHA class, decrease in left ventricular end systolic volume [LVESV] by >15%), dyssynchrony, and myocardial strain. RESULTS After 6 months of follow-up, the two RV lead locations represented a significant improvement in 6MWT, left ventricular ejection fraction, and LVESV in comparison to baseline values, but no significant difference was found between both groups. With regards to NYHA class improvement, p values were insignificant between the groups (0.44 and 0.88) at baseline and 6 months after implantation, respectively. The mean 6MWT was 273.8 m in the RVA group compared to 279.0 m in the RVS group (p = 0.84) at baseline. After 6 months of CRT implantation, the 6MWT mean was 326.5 m in the RVA group compared to 316.2 m in the RVS group (p = 0.74). The posterolateral cardiac vein site showed a significant improvement when combined with RVS location in interventricular and intraventricular dyssynchrony, global longitudinal strain, global circumferential strain, and apical circumferential strain (p = 0.01 0.032, 0.02, 0.005, and 0.049), respectively. CONCLUSION RVS is not inferior and provides a good alternative to RVA pacing in short-term follow-up. However, the QRS duration, myocardial strain, and dyssynchrony varies depending on RV and LV stimulation sites. Long-term morbidity and mortality outcomes according to LV lead location in coronary sinus need more assessment.
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Affiliation(s)
- Alaa S Algazzar
- Division of Cardiology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | | | | | | | | | - Mohammed A Qutub
- Division of Cardiology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Walters TE, Rahmutula D, Szilagyi J, Alhede C, Sievers R, Fang Q, Olgin J, Gerstenfeld EP. Left Ventricular Dyssynchrony Predicts the Cardiomyopathy Associated With Premature Ventricular Contractions. J Am Coll Cardiol 2019; 72:2870-2882. [PMID: 30522650 DOI: 10.1016/j.jacc.2018.09.059] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The pathophysiology of cardiomyopathy associated with premature ventricular contractions (PVCs) remains unclear. OBJECTIVES This study prospectively explored cardiomyopathy development in a swine model of paced ectopic beats. METHODS A total of 35 swine underwent pacemaker implantation. A group exposed to paced bigeminy from the right ventricular apex (RVA) for 14 weeks (RVA PVC) (n = 10) were compared with a group exposed to regular pacing from the RVA at 140 beats/min (RV-140) (n = 5) and a control group (n = 5). To test the role of ectopic beat dyssynchrony, further groups were exposed for 12 weeks to bigeminy from the right ventricular free wall (RVFW PVC) (n = 5), the left ventricular epicardium (LV Epi PVC) (n = 5) or the right atrium (premature atrial complex) (n = 5). RESULTS After 14 weeks, the mean left ventricular ejection fraction (LVEF) was significantly lower in the RVA PVC group than in the RV-140 or control groups (p < 0.05). LVEF declined significantly in the LV Epi PVC (65.2 ± 2.4% to 39.7 ± 3.0%; p < 0.01) and RVFW PVC (66.1 ± 2.6% to 48.6 ± 2.7%; p < 0.01) groups, with final LVEF significantly lower and ventricular fibrosis significantly higher in the LV Epi PVC group compared with all others (p < 0.05). Protein levels of pRyR2, NCX-1, CaMKII-α, and PLN were up-regulated and levels of SERCA2a were down-regulated in the LV Epi PVC group compared with the control group (p < 0.05). Longer ectopic beat QRS duration and greater LV dyssynchrony were significantly associated with larger declines in LV systolic function. CONCLUSIONS In a swine model of paced ectopic beats, PVC-induced cardiomyopathy is phenotypically distinct from a tachycardia-induced cardiomyopathy. Cardiomyopathy severity is strongly associated with severity of the hemodynamic derangement associated with the paced ectopic beats, particularly the extent of LV dyssynchrony.
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Affiliation(s)
- Tomos E Walters
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Dolkun Rahmutula
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Judit Szilagyi
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Christina Alhede
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Richard Sievers
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Qizhi Fang
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Jeffrey Olgin
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California.
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16
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Beurskens NE, Tjong FV, de Bruin-Bon RH, Dasselaar KJ, Kuijt WJ, Wilde AA, Knops RE. Impact of Leadless Pacemaker Therapy on Cardiac and Atrioventricular Valve Function Through 12 Months of Follow-Up. Circ Arrhythm Electrophysiol 2019; 12:e007124. [DOI: 10.1161/circep.118.007124] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Niek E.G. Beurskens
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, the Netherlands
| | - Fleur V.Y. Tjong
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, the Netherlands
| | - Rianne H.A. de Bruin-Bon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, the Netherlands
| | - Kosse J. Dasselaar
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, the Netherlands
| | - Wichert J. Kuijt
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, the Netherlands
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, the Netherlands
| | - Reinoud E. Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, the Netherlands
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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
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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
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18
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Okada M, Kashiwase K, Hirata A, Takeda Y, Amiya R, Ueda Y, Higuchi Y, Yasumura Y. Clinical Influence and Predictors of Pacing-Induced Mechanical Asynchrony in Patients with Normal Cardiac Function with Ventricular Lead Placed in Non-Apical Position. Int Heart J 2018; 59:1275-1287. [PMID: 30393263 DOI: 10.1536/ihj.17-672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right ventricular apical (RVA) pacing often causes left ventricular (LV) mechanical asynchrony, which is enhanced by impaired cardiac contraction and intrinsic conduction abnormality. However, data on patients with normal cardiac function and under RV non-apical (non-RVA) pacing are limited.We retrospectively investigated 97 consecutive patients with normal ejection fraction who received pacemaker implantation for atrioventricular block with the ventricular lead placed in a non-RVA position. We defined mechanical asynchrony as discoordinate contraction between opposing regions of the LV wall evaluated by echocardiography. Asynchrony was detected in 9 (9%) patients at baseline and in 38 (39%) under non-RVA pacing (P < 0.001). Asynchrony at baseline was significantly associated with complete left bundle branch block (CLBBB) [odds ratio (OR) = 20.8, P < 0.001]. Asynchrony under non-RVA pacing was significantly associated with left anterior fascicular block (LAFB) (OR = 7.14, P < 0.001) and CLBBB (OR = 13.3, P = 0.002) at baseline. New occurrence of asynchrony was significantly associated with LAFB at baseline (OR = 5.88, P = 0.001). During a median follow-up period of 4.8 years, the incidence of device-detected atrial fibrillation (AF) was more frequent in patients who developed asynchrony than in those who did not (53.3% versus 27.5%, hazard ratio = 2.17, 95% confidence interval = 1.02-4.61, P = 0.03).In patients with normal cardiac function, LAFB at baseline was significantly associated with new occurrence of mechanical asynchrony under non-RVA pacing. Abnormal contraction had a significant influence on the incidence of device-detected AF.
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Affiliation(s)
| | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
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19
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Nguyên UC, Verzaal NJ, van Nieuwenhoven FA, Vernooy K, Prinzen FW. Pathobiology of cardiac dyssynchrony and resynchronization therapy. Europace 2018; 20:1898-1909. [DOI: 10.1093/europace/euy035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Nienke J Verzaal
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frans A van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
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20
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Mohananey D, Jobanputra Y, Kumar A, Krishnaswamy A, Mick S, White JM, Kapadia SR. Clinical and Echocardiographic Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: Meta-Analysis and Meta-Regression. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005046. [PMID: 28698290 DOI: 10.1161/circinterventions.117.005046] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement has become the procedure of choice for inoperable, high-risk, and many intermediate-risk patients with aortic stenosis. Conduction abnormalities are a common finding after transcatheter aortic valve replacement and often result in permanent pacemaker (PPM) implantation. Data pertaining to the clinical impact of PPM implantation are controversial. We used meta-analysis techniques to summarize the effect of PPM implantation on clinical and echocardiographic outcomes after transcatheter aortic valve replacement. METHODS AND RESULTS Data were summarized as Mantel-Haenszel relative risk (RR) and 95% confidence intervals (CIs) for dichotomous variables and as standardized mean difference and 95% CI for continuous variables We used the Higgins I2 statistic to evaluate heterogeneity. We found that patients with and without PPM have similar all-cause mortality (RR, 0.85; 95% CI, 0.70-1.03), cardiovascular mortality (RR, 0.84; 95% CI, 0.59-1.18), myocardial infarction (RR, 0.47; 95% CI, 0.20-1.11), and stroke (RR, 1.26; 95% CI, 0.70-2.26) at 30 days. The groups were also comparable in all-cause mortality (RR, 1.03; 95% CI, 0.92-1.16), cardiovascular mortality (RR, 0.69; 95% CI, 0.39-1.24), myocardial infarction (RR, 0.58; 95% CI, 0.30-1.13), and stroke (RR, 0.70; 95% CI, 0.47-1.04) at 1 year. We observed that the improvement in left ventricular ejection fraction was significantly greater in the patients without PPM (standardized mean difference, 0.22; 95% CI, 0.12-0.32). CONCLUSIONS PPM implantation is not associated with increased risk of all-cause mortality, cardiovascular mortality, stroke, or myocardial infarction both at short- and long-term follow-up. However, PPM is associated with impaired left ventricular ejection fraction recovery post-transcatheter aortic valve replacement.
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Affiliation(s)
- Divyanshu Mohananey
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH.
| | - Yash Jobanputra
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Arnav Kumar
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Amar Krishnaswamy
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Stephanie Mick
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Jonathon M White
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Samir R Kapadia
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
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21
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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.
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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
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22
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Mahfouz RA, Alawady WS, Salem A. Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging. Echocardiography 2017; 34:1667-1673. [DOI: 10.1111/echo.13720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ragab A. Mahfouz
- Department of Cardiology; Zagazig University Hospital; Zagazig Egypt
| | - Waleed S. Alawady
- Department of Cardiology; Zagazig University Hospital; Zagazig Egypt
| | - Abdelhakeem Salem
- Department of Cardiology; Zagazig University Hospital; Zagazig Egypt
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23
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Cronin EM, Jones P, Seth MC, Varma N. Right Ventricular Pacing Increases Risk of Appropriate Implantable Cardioverter-Defibrillator Shocks Asymmetrically: An Analysis of the ALTITUDE Database. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004711. [PMID: 29030379 DOI: 10.1161/circep.116.004711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 08/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Right ventricular pacing (RVP) increases risk of atrial fibrillation in patients with implantable cardioverter-defibrillators (ICDs), but ventricular proarrhythmia is less clear. We analyzed a large remote monitoring database to assess this question. METHODS AND RESULTS Patients with single- or dual-chamber ICDs, engaged in remote monitoring for at least 6 months and with unchanged tachycardia programming, were included. %RVP was derived for each weekly transmission. ICD electrograms preceding the first shock were adjudicated. Among 425 625 transmissions received from 8435 patients, 389 appropriate shocks occurred over a mean follow-up of 15.0±8.8 months. In a time-dependent Cox proportional hazards model, transmissions with 80% to 98% RVP were associated with a hazard ratio of 1.56 for an appropriate shock in the subsequent week compared with <1% RVP (95% CI, 1.01-2.41; P=0.04). By contrast, ≥98% RVP trended toward a lower risk of an appropriate shock (hazard ratio, 0.61; 95% CI, 0.33-1.12; P=0.108). Lifetime cumulative %RVP was closely correlated with weekly %RVP (R2=0.907) and was similarly associated with increased risk of appropriate shocks at 80% to 98% RVP (hazard ratio, 1.57; 95% CI, 1.01-2.44; P=0.046) but not at ≥98% RVP (hazard ratio, 0.49; 95% CI, 0.24-1.01; P=0.052). These results were driven by dual-chamber devices, but unaffected by PVC counts or programming. Male sex and age were also associated with appropriate ICD shocks. CONCLUSIONS Increasing frequency of RVP is associated with a progressively increased risk of appropriate ICD shocks until ≥98% RVP. RVP may have ventricular proarrhythmia because of competition of paced and intrinsic rhythm in ICD patients.
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Affiliation(s)
- Edmond M Cronin
- From the Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, CT (E.M.C.); Boston Scientific, St. Paul, MN (P.J., M.C.S.); and Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (N.V.).
| | - Paul Jones
- From the Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, CT (E.M.C.); Boston Scientific, St. Paul, MN (P.J., M.C.S.); and Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (N.V.)
| | - Milan C Seth
- From the Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, CT (E.M.C.); Boston Scientific, St. Paul, MN (P.J., M.C.S.); and Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (N.V.)
| | - Niraj Varma
- From the Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, CT (E.M.C.); Boston Scientific, St. Paul, MN (P.J., M.C.S.); and Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (N.V.)
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24
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Prominent differences in left ventricular performance and myocardial properties between right ventricular and left ventricular-based pacing modes in rats. Sci Rep 2017; 7:5931. [PMID: 28725029 PMCID: PMC5517524 DOI: 10.1038/s41598-017-06197-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023] Open
Abstract
Biventricular pacing is an important modality to improve left ventricular (LV) synchronization and long-term function. However, the biological effects of this treatment are far from being elucidated and existing animal models are limited and demanding. Recently, we introduced an implanted device for double-site epicardial pacing in rats and echocardiographically demonstrated favorable effects of LV and biventricular (LV-based) pacing modes typically observed in humans. Here, this new animal model was further characterized. Electrodes were implanted either on the right atria (RA) and right ventricle (RV) or on the RV and LV. Following recovery, rats were either used for invasive hemodynamic measurements (pressure-volume analysis) or exposed to sustained RV vs. biventricular tachypacing for 3 days. RV pacing compromised, while LV-based pacing modes markedly enhanced cardiac performance. Changes in LV performance were associated with prominent compensatory changes in arterial resistance. Sustained RV tachypacing increased the electrocardiogram QTc interval by 7.9 ± 3.1 ms (n = 6, p < 0.05), dispersed refractoriness between the right and left pacing sites and induced important molecular changes mainly in the early-activated septal tissue. These effects were not observed during biventricular tachypacing (n = 6). Our results demonstrate that the rat is an attractive new model to study the biological consequences of LV dyssynchrony and resynchronization.
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Karpawich PP, Bansal N, Samuel S, Sanil Y, Zelin K. 16 Years of Cardiac Resynchronization Pacing Among Congenital Heart Disease Patients: Direct Contractility (dP/dt-max) Screening When the Guidelines Do Not Apply. JACC Clin Electrophysiol 2017; 3:830-841. [PMID: 29759779 DOI: 10.1016/j.jacep.2017.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/29/2016] [Accepted: 01/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of this study was to use direct cardiac resynchronization therapy (CRT)-paced contractility (dP/dt-max) response as a pre-implantation evaluation among patients with congenital heart disease (CHD) and follow clinical parameters and contractility indexes after CRT implantation. BACKGROUND Patients with CHD often develop early heart failure with few therapeutic options, leading to heart transplantation (HT). Unfortunately, guidelines for CRT do not apply, and function evaluations by cardiac ultrasound are often inaccurate among CHD anatomies. Therefore, which CHD patients would benefit from CRT remains an enigma. METHODS From 1999 to 2015, 103 CHD patients with New York Heart Association (NYHA) functional class II to IV were listed for HT; 40 patients on optimal medical therapy were referred for paced contractility response cardiac catheterization before CRT consideration. If dP/dt-max improved ≥15% from baseline, these "responders" were given the option of CRT with continued follow-up after implantation. RESULTS Of 40 patients studied, 26 (65%) (age 22 ± 8.2 years; 9 of 26 [35%] single or systemic right ventricle; 17 of 26 [65%] with pacemakers) met criteria for possible hemodynamic benefit and underwent CRT implantation. All 26 patients improved in NYHA functional classification: 5 of 26 patients (19%) were later relisted for HT (4 to 144 months, mean 55 months) after CRT implantation, whereas 21 of 26 (81%) continued with improved NYHA functional class (12 to 112 months, mean 44 months) later. A repeat dP/dt-max study following long-term CRT showed stable function or continued contractility improvement. CONCLUSIONS Heart failure is common among CHD patients, and therapies are limited. CRT guidelines do not address clinical and anatomic issues of CHD. Short-term paced contractility response testing identifies those CHD patients who are likely to respond to CRT regardless of anatomy.
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Affiliation(s)
- Peter P Karpawich
- Section of Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
| | - Neha Bansal
- Section of Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Sharmeen Samuel
- Section of Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Yamuna Sanil
- Section of Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Kathleen Zelin
- Section of Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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Faghfourian Md B, Homayoonfar Md S, Rezvanjoo Md M, Poorolajal Md PhD J, Emam Md AH. Comparison of hemodynamic effects of biventricular versus left ventricular only pacing in patients receiving cardiac resynchronization therapy: A before-after clinical trial. J Arrhythm 2017; 33:127-129. [PMID: 28416979 PMCID: PMC5388040 DOI: 10.1016/j.joa.2016.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 11/11/2022] Open
Abstract
Background Biventricular (BiV) pacing is the most common mode of delivering cardiac resynchronization therapy (CRT). However, initial clinical studies have indicated that left ventricular (LV) pacing is not inferior to BiV pacing. This study was conducted to address whether LV only pacing can provide the same hemodynamic response as BiV pacing. Methods This before–after clinical trial was conducted at Ekbatan Hospital, from July 2012 to November 2014. Patients with a LV ejection fraction ≤35% and a QRS duration ≥0.12 s who had a standard indication for ventricular pacing were enrolled. The CRT devices of all patients had already been set for BiV pacing. Therefore, their CRT devices were set for LV only pacing for 3 months. The hemodynamic status of the patients was assessed by echocardiography before setting the CRT device to LV only pacing (as a control) and 3 months after (as an intervention). Results There was no statistically significant difference between the effect of BiV pacing and LV only pacing on the hemodynamic responses including LV ejection fraction, LV end diastolic and systolic volume, and velocity time integral of the aortic valve. Moreover, no significant difference was seen between men and women either. Conclusions LV only pacing is not inferior to BiV pacing, and the hemodynamic response was similar in the two groups. However, the LV mode has a number of advantages over the BiV mode. More evidence, based on large clinical trials, is needed to confirm our results.
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Affiliation(s)
- Babak Faghfourian Md
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Clinical Research Development Unit of Farshcian Cardiology Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahram Homayoonfar Md
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Clinical Research Development Unit of Farshcian Cardiology Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Rezvanjoo Md
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal Md PhD
- Modeling of Noncommunicable Diseases Research Center, Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Hossein Emam Md
- Clinical Research Development Unit of Farshcian Cardiology Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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Sramko M, Wichterle D, Kautzner J. Feasibility of In-Vivo Simulation of Acute Hemodynamics in Human Atrial Fibrillation. PLoS One 2016; 11:e0165241. [PMID: 27764240 PMCID: PMC5072830 DOI: 10.1371/journal.pone.0165241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/07/2016] [Indexed: 11/18/2022] Open
Abstract
This study evaluated hemodynamic feasibility and reproducibility of a new method for in vivo simulation of human atrial fibrillation (AF). The method was tested during sinus rhythm in 10 patients undergoing catheter ablation for AF. A simple electronic device was assembled that allowed triggering a cardiac stimulator by predefined series of RR intervals. Irregular RR interval sequences with a mean heart rate of 90/min and 130/min were obtained from ECG recordings of another patients with AF. Simultaneous atrioventricular pacing was delivered by catheters placed inside the coronary sinus and at the His bundle region. Hemodynamic effect of the simulated AF was assessed by invasive measurement of the left ventricular (LV) pressure, dP/dt, and Tau. Compared to regular pacing at the same mean heart rate, the simulated AF significantly impaired the LV both systolic and diastolic function. Repeated AF pacing in the same patients generated similar LV hemodynamics. The proposed method provides a realistic and reproducible in-vivo model of AF. It can be exploited for investigation of the hemodynamic consequences of AF in various patient populations.
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Affiliation(s)
- Marek Sramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- * E-mail:
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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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]
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Mafi-Rad M, Luermans JGLM, Blaauw Y, Janssen M, Crijns HJ, Prinzen FW, Vernooy K. Feasibility and Acute Hemodynamic Effect of Left Ventricular Septal Pacing by Transvenous Approach Through the Interventricular Septum. Circ Arrhythm Electrophysiol 2016; 9:e003344. [PMID: 26888445 DOI: 10.1161/circep.115.003344] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular septal (LVS) pacing reduces ventricular dyssynchrony and improves cardiac function relative to right ventricular apex (RVA) pacing in animals. We aimed to establish permanent placement of an LVS pacing lead in patients using a transvenous approach through the interventricular septum. METHODS AND RESULTS Ten patients with sinus node dysfunction scheduled for dual-chamber pacemaker implantation were prospectively enrolled. A custom pacing lead with extended helix was introduced via the left subclavian vein and, after positioning against the right ventricular septum (RVS) using a preshaped guiding catheter, driven through the interventricular septum to the LVS. The acute hemodynamic effect of RVA, RVS, and LVS pacing was evaluated by invasive LVdP/dtmax measurements. The lead was successfully delivered to the LVS in all patients. Procedure time and fluoroscopy time shortened with experience. QRS duration was shorter during LVS pacing (144 ± 20 ms) than during RVA (172 ± 33 ms; P = 0.02 versus LVS) and RVS pacing (165 ± 17 ms; P = 0.004 versus LVS). RVA and RVS pacing reduced LVdP/dtmax compared with baseline atrial pacing (-7.1 ± 4.1% and -6.9 ± 4.3%, respectively), whereas LVS pacing maintained LVdP/dtmax at baseline level (1.0 ± 4.3%; P = 0.001 versus RVA and RVS). R-wave amplitude and pacing threshold were 12.2 ± 6.7 mV and 0.5 ± 0.2 V at implant and remained stable during 6-month follow-up without lead-related complications. CONCLUSIONS Permanent placement of an LVS pacing lead by transvenous approach through the interventricular septum is feasible in patients. LVS pacing preserves acute left ventricular pump function. This new pacing method could serve as an alternative and hemodynamically preferable approach for antibradycardia pacing.
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Affiliation(s)
- Masih Mafi-Rad
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Justin G L M Luermans
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Yuri Blaauw
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Michel Janssen
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Harry J Crijns
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Frits W Prinzen
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Kevin Vernooy
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.).
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Yang JH, Kim JY, Kim SH, Oh YS. Reversal of Pacing-Induced Cardiomyopathy by Normal QRS Axis Pacing. Korean Circ J 2016; 46:421-4. [PMID: 27275181 PMCID: PMC4891609 DOI: 10.4070/kcj.2016.46.3.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/08/2015] [Accepted: 10/27/2015] [Indexed: 12/05/2022] Open
Abstract
Right ventricular apical pacing has been a commonly used method for placement of permanent pacemaker, but it is known to be associated with ventricular dyssynchrony and may lead to heart failure. Septal pacing could be an alternative method to improve this complication but the results have been conflicting; hence, other strategies are needed. This case is about a patient with pacing-induced cardiomyopathy who showed much improvement after repositioning the leads to a site different from that of normally paced QRS axis.
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Affiliation(s)
- Ji Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Cicchitti V, Radico F, Bianco F, Gallina S, Tonti G, De Caterina R. Heart failure due to right ventricular apical pacing: the importance of flow patterns. Europace 2016; 18:1679-1688. [DOI: 10.1093/europace/euw024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/25/2016] [Indexed: 01/12/2023] Open
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Choudhary D, Chaurasia AK, Kumar SM, Arulkumar A, Thajudeen A, Namboodiri N, Sanjay G, Abhilash SP, Ajitkumar VK, Ja T. Radial left ventricular dyssynchrony by speckle tracking in apical versus non apical right ventricular pacing- evidence of dyssynchrony on medium term follow up. J Cardiovasc Thorac Res 2016; 8:20-5. [PMID: 27069563 PMCID: PMC4827135 DOI: 10.15171/jcvtr.2016.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/09/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION To study effects of various sites of right ventricular pacing lead implantation on left ventricular function by 2-dimensional (2D) speckle tracking for radial strain and LV dyssynchrony. METHODS This was retrospective prospective study. Fifteen patients each with right ventricular (RV) apical (RV apex and apical septum) and non-apical (mid septal and low right ventricular outflow tract [RVOT]) were programmed to obtain 100% ventricular pacing for evaluation by echo. Location and orientation of lead tip was noted and archived by fluoroscopy. Electrocardiography (ECG) was archived and 2D echo radial dyssynchrony was calculated. RESULTS The baseline data was similar between two groups. Intraventricular dyssynchrony was significantly more in apical location as compared to non-apical location (radial dyssynchrony: 108.2 ± 50.2 vs. 50.5 ± 24, P < 0.001; septal to posterior wall delay [SLWD] 63.5 ± 27.5 vs. 34 ± 10.7, P < 0.001, SPWD 112.5 ± 58.1 vs. 62.7 ± 12.1, P = 0.003). The left ventricular ejection fraction was decreased more in apical location than non apical location. Interventricular dyssynchrony was more in apical group but was not statistically significant. The QRS duration, QTc and lead thresholds were higher in apical group but not statistically significant. CONCLUSION Pacing in non apical location (RV mid septum or low RVOT) is associated with less dyssynchrony by specific measures like 2D radial strain and correlates with better ventricular function in long term.
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Affiliation(s)
- Dinesh Choudhary
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Amit Kumar Chaurasia
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - S Mahesh Kumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Ajeet Arulkumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Anees Thajudeen
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - G Sanjay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - S P Abhilash
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - V K Ajitkumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Tharakan Ja
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
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Ebrille E, DeSimone CV, Vaidya VR, Chahal AA, Nkomo VT, Asirvatham SJ. Ventricular pacing - Electromechanical consequences and valvular function. Indian Pacing Electrophysiol J 2016; 16:19-30. [PMID: 27485561 PMCID: PMC4936653 DOI: 10.1016/j.ipej.2016.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although great strides have been made in the areas of ventricular pacing, it is still appreciated that dyssynchrony can be malignant, and that appropriately placed pacing leads may ameliorate mechanical dyssynchrony. However, the unknowns at present include: 1. The mechanisms by which ventricular pacing itself can induce dyssynchrony; 2. Whether or not various pacing locations can decrease the deleterious effects caused by ventricular pacing; 3. The impact of novel methods of pacing, such as atrioventricular septal, lead-less, and far-field surface stimulation; 4. The utility of ECG and echocardiography in predicting response to therapy and/or development of dyssynchrony in the setting of cardiac resynchronization therapy (CRT) lead placement; 5. The impact of ventricular pacing-induced dyssynchrony on valvular function, and how lead position correlates to potential improvement. This review examines the existing literature to put these issues into context, to provide a basis for understanding how electrical, mechanical, and functional aspects of the heart can be distorted with ventricular pacing. We highlight the central role of the mitral valve and its function as it relates to pacing strategies, especially in the setting of CRT. We also provide future directions for improved pacing modalities via alternative pacing sites and speculate over mechanisms on how lead position may affect the critical function of the mitral valve and thus overall efficacy of CRT.
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Affiliation(s)
- Elisa Ebrille
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Anwar A Chahal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Clinical and Translational Science, Mayo Graduate School, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Chen D, Wei H, Tang J, Liu L, Wu S, Lin C, Zhang Q, Liang Y, Chen S. A randomized comparison of fluoroscopic techniques for implanting pacemaker lead on the right ventricular outflow tract septum. Int J Cardiovasc Imaging 2016; 32:721-8. [PMID: 26797500 PMCID: PMC4853443 DOI: 10.1007/s10554-016-0840-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/10/2016] [Indexed: 01/21/2023]
Abstract
Right ventricular outflow tract (RVOT) septal pacing is commonly performed under the standard fluoroscopic positions during procedure. The aim of the prospective, randomized study was to evaluate the accuracy of the combination of standard fluoroscopic and left lateral (LL) fluoroscopic views for determination of RVOT septal position compared with standard fluoroscopic views alone. We prospectively enrolled patients who had indications for implantation of a permanent pacemaker. Patients were randomly assigned into two groups based on intraoperative fluoroscopic views as follows: LL group (three standard fluoroscopic views + LL fluoroscopic view) or standard group (three standard fluoroscopic views). Transthoracic echocardiography (TTE) determination of pacing sites was applied in all patients 3 days after pacemaker implantation. The implantation success rate of RVOT septal pacing was compared between groups. A total of 143 patients (59 males, mean age 57.6 ± 16.3 years) with symptomatic bradyarrhythmia were studied, of whom, 72 patients were randomized to LL group and 71 to standard group. TTE determination of pacing sites was compared with two groups. In the LL group, 60 patients (83 %) were achieved in RVOT septal position. In the standard group, however, the position of RVOT septum was only observed in 48 patients (68 %). The success rate of RVOT septal position in LL group was significantly higher than standard group (p = 0.029). Comparing to traditional views, combining LL view in the procedure will approve the accuracy of RVOT septal pacing site.
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Affiliation(s)
- Dongli Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Huiqiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Jiaojiao Tang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Lie Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Chunying Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Qianhuan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Yuanhong Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Silin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
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Wu L, de Roest GJ, Hendriks ML, van Rossum AC, de Cock CC, Allaart CP. The influence of right ventricular stimulation on acute response to cardiac resynchronisation therapy. Neth Heart J 2015; 24:66-72. [PMID: 26649436 PMCID: PMC4692833 DOI: 10.1007/s12471-015-0770-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The contribution of right ventricular (RV) stimulation to cardiac resynchronisation therapy (CRT) remains controversial. RV stimulation might be associated with adverse haemodynamic effects, dependent on intrinsic right bundle branch conduction, presence of scar, RV function and other factors which may partly explain non-response to CRT. This study investigates to what degree RV stimulation modulates response to biventricular (BiV) stimulation in CRT candidates and which baseline factors, assessed by cardiac magnetic resonance imaging, determine this modulation. Methods and results Forty-one patients (24 (59 %) males, 67 ± 10 years, QRS 153 ± 22 ms, 21 (51 %) ischaemic cardiomyopathy, left ventricular (LV) ejection fraction 25 ± 7 %), who successfully underwent temporary stimulation with pacing leads in the RV apex (RVapex) and left ventricular posterolateral (PL) wall were included. Stroke work, assessed by a conductance catheter, was used to assess acute haemodynamic response during baseline conditions and RVapex, PL (LV) and PL+RVapex (BiV) stimulation. Compared with baseline, stroke work improved similarly during LV and BiV stimulation (∆+ 51 ± 42 % and ∆+ 48 ± 47 %, both p < 0.001), but individual response showed substantial differences between LV and BiV stimulation. Multivariate analysis revealed that RV ejection fraction (β = 1.01, p = 0.02) was an independent predictor for stroke work response during LV stimulation, but not for BiV stimulation. Other parameters, including atrioventricular delay and scar presence and localisation, did not predict stroke work response in CRT. Conclusion The haemodynamic effect of addition of RVapex stimulation to LV stimulation differs widely among patients receiving CRT. Poor RV function is associated with poor response to LV but not BiV stimulation. Electronic supplementary material The online version of this article (doi:10.1007/s12471-015-0770-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Wu
- Department of Cardiology, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, Amsterdam, The Netherlands.
| | - G J de Roest
- Department of Cardiology, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - M L Hendriks
- Department of Cardiology, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - A C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - C C de Cock
- Department of Cardiology, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - C P Allaart
- Department of Cardiology, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, Amsterdam, The Netherlands
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Sequential radial and circumferential strain and oxidative stress assessment in dogs with tachycardia-induced cardiac dysfunction. Int J Cardiovasc Imaging 2015; 32:583-91. [DOI: 10.1007/s10554-015-0812-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
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Abstract
Phase analysis of gated myocardial perfusion single-photon emission computed tomography is a widely available and reproducible measure of left ventricular (LV) dyssynchrony, which also provides comprehensive assessment of LV function, global and regional scar burden, and patterns of LV mechanical activation. Preliminary studies indicate potential use in predicting cardiac resynchronization therapy response and elucidation of mechanisms. Because advances in technology may expand capabilities for precise LV lead placement in the future, identification of specific patterns of dyssynchrony may have a critical role in guiding cardiac resynchronization therapy.
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Husby MP, Soliman EZ, Goldberger JJ, Liu K, Lloyd-Jones D, Durazo-Arvizu R, Kramer H. The Association between the PR Interval and Left Ventricular Measurements in the Multiethnic Study of Atherosclerosis. Cardiol Res Pract 2015; 2015:193698. [PMID: 26558133 PMCID: PMC4629021 DOI: 10.1155/2015/193698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/23/2015] [Accepted: 09/09/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Few studies have examined the association between the PR interval (PRi) and subclinical cardiovascular disease measures. Methods and Results. The Multiethnic Study of Atherosclerosis (MESA) is a population-based study of 6814 men and women aged 45-84 years without clinical cardiovascular disease and 4962 had complete baseline data on cardiac magnetic resonance imaging measures of LV dimension and ejection fraction and surface electrocardiogram. Linear regression models were constructed to determine the adjusted association between the PRi and measures of LV stroke volume, LV mass, LV end-systolic and end-diastolic volumes, and ejection fraction. Overall, mean age was 61.5 years, and 47.6% were male and race/ethnicity was white in 39.1%, Chinese in 13.1%, African-American in 25.7%, and Hispanic in 22.2%. The PRi ranged from 88 to 308 ms with a median value of 162 ms. As a continuous variable, every standard deviation unit (25 ms) increment in PRi was associated with a 2.00 mL (95% CI 1.52, 2.48) higher stroke volume, a 3.08 g (95% CI 2.30, 3.86) higher LV mass, a 1.36 g/m(2) (95% CI 0.96, 1.76) higher LV mass index, and 1.31 mL (95% CI 0.88, 1.73) higher end-systolic and 3.31 mL (95% CI 2.58, 4.03) higher end-diastolic volumes after adjustment for all covariates. No significant association was noted between the PRi and LV ejection fraction. Conclusions. A prolonged PRi is associated with LV measures and may in part explain the link between a prolonged PRi and cardiovascular outcomes.
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Affiliation(s)
- Michael P. Husby
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL 60153, USA
| | - Elsayed Z. Soliman
- Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
| | - Jeffrey J. Goldberger
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Don Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Ramon Durazo-Arvizu
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL 60153, USA
| | - Holly Kramer
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL 60153, USA
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41
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Kaye G. Pacing site in pacemaker dependency: is right ventricular septal lead position the answer? Expert Rev Cardiovasc Ther 2015; 12:1407-17. [PMID: 25418757 DOI: 10.1586/14779072.2014.979791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The right ventricular apex has been the traditional site for lead placement in patients with atrioventricular block. Pacing at the right ventricular apex may have long-term deleterious effects on left ventricular (LV) function, promoting heart failure and increasing mortality. Pacing at the right ventricular septum has been proposed to minimize deterioration in LV function. Although experimental data suggest that septal pacing protects LV function, clinical studies have provided conflicting results. A recent large study in patients with heart block did not show a protective effect with septal pacing. Other pacing approaches are becoming increasingly relevant; however, prediction of what method should be employed in which patient is not currently possible. Other factors such as baseline LV function and associated co-morbidities impact LV function, irrespective of pacing site. Continued monitoring of cardiac function post-implant is therefore critical to ongoing care. An algorithm for managing patients with atrioventricular block is proposed.
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Affiliation(s)
- Gerry Kaye
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba and University of Queensland, Brisbane 4102, Australia
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42
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Kırış A, Kırış G, Turan OE, Öztürk M, Şahin M, İlter A, Bektaş O, Kutlu M, Kaplan Ş, Gedikli Ö. Relationship between epicardial fat tissue and left ventricular synchronicity: An observational study. Anatol J Cardiol 2015; 15:990-4. [PMID: 25880051 PMCID: PMC5368471 DOI: 10.5152/akd.2014.5877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: Left ventricular (LV) systolic synchrony is defined as simultaneous activation of corresponding cardiac segments. Impaired synchrony has some adverse cardiovascular effects, such as LV dysfunction and impaired prognosis. Epicardial fat tissue (EFT) is visceral fat around the heart. Increased EFT thickness is associated with some disorders, such as LV dysfunction and hypertrophy, which play a role in the impairment of LV synchrony. However, the relationship between EFT and LV systolic synchrony has never been assessed. Thus, we aimed to evaluate the possible relationship between EFT and LV synchrony in this study. Methods: The study population consisted of 55 consecutive patients (mean age 46.4±13.4 years, 32 female) without bundle branch block (BBB). EFT and LV systolic synchrony were evaluated by transthoracic echocardiography using 2D and tissue Doppler imaging. Maximal difference (Ts-6) and standard deviation (Ts-SD-6) of time to peak systolic (Ts) myocardial tissue velocity obtained from 6 LV basal segments were used to assess LV synchrony. Multiple regression analysis was used to detect the independently related factors to LV synchrony. Results: The mean values of EFT thickness, Ts-6, and Ts-SD-6 were found to be 2.7±1.6 mm (ranging from 1-7 mm), 20.1±14.2 msec, and 7.7±5.6, respectively. EFT thickness also was independently associated with Ts-6 (β =0.332, p=0.01) and Ts-SD-6 (β =0.286, p=0.04). Conclusion: EFT thickness is associated with LV systolic synchrony in patients without BBB.
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Affiliation(s)
- Abdulkadir Kırış
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University; Trabzon-Turkey.
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43
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Chiladakis J, Kalogeropoulos A, Zagkli F, Chouchoulis K. Effect of heart rate on the intrinsic and the ventricular-paced QRS duration. J Electrocardiol 2015; 48:689-95. [PMID: 25959261 DOI: 10.1016/j.jelectrocard.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the effect of heart rate on the intrinsic and the ventricular-paced QRS duration in implanted device recipients with normal or reduced left ventricular ejection fraction (EF). METHODS We studied 239 outpatients with preserved intrinsic ventricular activation and normal (n=92) or reduced (n=147) EF who had apical (RVA) or mid-septal (RVS) right ventricular lead position. The QRS duration was measured at baseline and during atrial-based pacing at increased heart rate to ensure intrinsic or ventricular-paced QRS activation. RESULTS The heart rate increase shortened the intrinsic QRS only in patients with normal EF, and further prolonged the ventricular-paced QRS in patients with reduced EF and either narrow or wide QRS (p<0.001), irrespective of RVA or RVS pacing (p<0.01). CONCLUSION Heart rate increase is associated with further QRS prolongation in patients with reduced EF, regardless of RVA or RVS pacing site.
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Affiliation(s)
- John Chiladakis
- Cardiology Department, Patras University Hospital, 26500 Rion, Patras, Greece.
| | | | - Fani Zagkli
- Cardiology Department, Patras University Hospital, 26500 Rion, Patras, Greece
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44
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Saito M, Kaye G, Negishi K, Linker N, Gammage M, Kosmala W, Marwick TH. Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing. Heart 2015; 101:600-8. [DOI: 10.1136/heartjnl-2014-306990] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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45
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Karpawich PP. Improving pacemaker therapy in congenital heart disease: contractility and resynchronization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2015; 18:51-56. [PMID: 25939843 DOI: 10.1053/j.pcsu.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/05/2014] [Indexed: 06/04/2023]
Abstract
Designed as effective therapy for patients with symptomatic bradycardia, implantable cardiac pacemakers initially served to improve symptoms and survival. With initial applications to the elderly and those with severe myocardial disease, extended longevity was not a major concern. However, with design technology advances in leads and generators since the 1980s, pacemaker therapy is now readily applicable to all age patients, including children with congenital heart defects. As a result, emphasis and clinical interests have advanced beyond simply quantity to quality of life. Adverse cardiac effects of pacing from right ventricular apical or epicardial sites with resultant left bundle branch QRS configurations have been recognized. As a result, and with the introduction of newer catheter-delivered pacing leads, more recent studies have focused on alternative or select pacing sites such as septal, outflow tract, and para-bundle of His. This is especially important in dealing with pacemaker therapy among younger patients and those with congenital heart disease, with expected decades of artificial cardiac stimulation, in which adverse myocellular changes secondary to pacing itself have been reported. As a correlate to these alternate or select pacing sites, applications of left ventricular pacing, either via the coronary sinus, intraseptal or epicardial, alone or in combination with right ventricular pacing, have gained interest for patients with heart failure. Although cardiac resynchronization pacing has, to date, had limited clinical applications among patients with congenital heart disease, the few published reports do indicate potential benefits as a bridge to cardiac transplant.
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Affiliation(s)
- Peter P Karpawich
- Section of Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI.
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46
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Kim SH, Oh YS, Nam GB, Choi KJ, Park JS, Park SW, Park SJ, On YK, Kim JS, Shin WS, Kim JH, Jang SW, Lee MY, Kim YH, Rho TH. Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction. J Interv Card Electrophysiol 2014; 41:223-9. [DOI: 10.1007/s10840-014-9950-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/10/2014] [Indexed: 12/01/2022]
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47
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Alhous MHA, Small GR, Hannah A, Hillis GS, Frenneaux M, Broadhurst PA. Right ventricular septal pacing as alternative for failed left ventricular lead implantation in cardiac resynchronization therapy candidates. Europace 2014; 17:94-100. [PMID: 25359384 DOI: 10.1093/europace/euu259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS To compare the effects on left ventricular (LV) function of right ventricular (RV) septal pacing vs. cardiac resynchronization therapy (CRT) in patients with an indication for the latter. Cardiac resynchronization therapy is an effective therapy in patients with drug-refractory heart failure. Despite advances in implantation techniques, LV lead placement can be impossible in up to 10% of cases. We, therefore, assessed the effects of RV septal pacing from mid septum (RVmIVS) and outflow tract (RVOT) on cardiac performance, in comparison with CRT. METHODS AND RESULTS Twenty-two patients scheduled for CRT underwent dual-chamber temporary pacing. The ventricular lead was placed at the RV apex (RVA), RVmIVS, and RVOT in random order. Comprehensive echocardiography was performed in a baseline AAI mode and then at each RV position in dual chamber pacemaker function (D pacing, D sensing, D dual responses) mode and repeated on the next day following CRT implantation. Right ventricular apex pacing did not change any of the assessed echocardiography parameters. Both RVmIVS and RVOT pacing increased LV ejection fraction (EF): 29 ± 7% at baseline vs. 32 ± 6% (P = 0.02) and 32 ± 5% (P = 0.04) with RVmIVS and RVOT pacing, respectively. Similarly, the dyssynchrony index (Ts-SD) decreased: 50 ± 19 ms at baseline vs. 39 ± 17 ms (P = 0.04) and 37 ± 17 ms (P = 0.006) with RVmIVS and RVOT pacing, respectively. Cardiac resynchronization therapy further improved LVEF and Ts-SD to 36 ± 7% and 34 ± 15 ms, respectively, however, only LVEF was significantly higher compared with RVmIVS and RVOT pacing (P = 0.03 and P = 0.01 respectively). There were no significant differences in either LVEF or Ts-SD between RVmIVS and RVOT. CONCLUSION Right ventricular septal pacing from mid septum or RVOT pacing improves LVEF and LV synchrony in CRT candidates. Further improvement in LVEF was achieved by CRT, which remains the 'gold standard' therapy in these patients. However, RV septal pacing is worthy of further study as an alternative strategy when LV lead implantation fails.
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Affiliation(s)
- M Hafez A Alhous
- Department of Cardiology, Aberdeen Royal Infirmary/University of Aberdeen, Aberdeen AB25 2ZN, UK
| | - Gary R Small
- Department of Cardiology, Aberdeen Royal Infirmary/University of Aberdeen, Aberdeen AB25 2ZN, UK
| | - Andrew Hannah
- Department of Cardiology, Aberdeen Royal Infirmary/University of Aberdeen, Aberdeen AB25 2ZN, UK
| | - Graham S Hillis
- The George Institute for Global Health, University of Sydney, Australia
| | - Michael Frenneaux
- Department of Cardiology, Aberdeen Royal Infirmary/University of Aberdeen, Aberdeen AB25 2ZN, UK
| | - Paul A Broadhurst
- Department of Cardiology, Aberdeen Royal Infirmary/University of Aberdeen, Aberdeen AB25 2ZN, UK
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48
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KARPAWICH PETERP, SINGH HARINDER, ZELIN KATHLEEN. Optimizing Paced Ventricular Function in Patients with and without Repaired Congenital Heart Disease by Contractility-Guided Lead Implant. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:54-62. [DOI: 10.1111/pace.12521] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 08/08/2014] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- PETER P. KARPAWICH
- Section of Cardiology; Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Michigan
| | - HARINDER SINGH
- Section of Cardiology; Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Michigan
| | - KATHLEEN ZELIN
- Section of Cardiology; Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Michigan
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49
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Soman P. Phase analysis of myocardial SPECT to understand mechanisms of disease and therapy. J Nucl Cardiol 2014; 21:967-9. [PMID: 25120133 DOI: 10.1007/s12350-014-9964-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA,
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50
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Lange JM, Manzolillo H, Parras J, Pozzer D, Reyes I, Pantich R. [Right ventricular septal stimulation would produce similar bi-ventricular dyssynchrony as does apical stimulation in patients with normal ejection fraction]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:183-90. [PMID: 25091614 DOI: 10.1016/j.acmx.2013.11.008] [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] [Received: 03/10/2013] [Revised: 11/23/2013] [Accepted: 11/28/2013] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To determine in patients with normal ejection fraction, undergoing permanent VVI pacing, if medial septal stimulation has lower dyssynchrony than apical stimulation assessed by echocardiography. METHOD A prospective trial, 19 patients>70 years old, scheduled for VVI pacemaker implantation for complete degenerative atrioventricular block, ventricular frequency<50beat per minute and ejection fraction≥45%. Patients with atrial fibrillation, heart failure, left bundle branch block and QRS durations longer than 120milliseconds in surface electrocardiogram with sinus rhythm were excluded. Patients were randomized to apical implantation group A: 47% and septal implantation group B: 53%. Echocardiographic parameters were measured previous to the implant, 48h, 5 and 48 months after implantation. RESULTS No patients had diagnosis of ischemic cardiomyopathy or heart failure. Echocardiographic parameters for interventricular dyssynchrony between groups were A: 14.44±19.76msec vs. B: 9±36.45msec; A: 6.11±62.11msec vs. B: 13±38.31msec; A: 77±53.51msec vs. B: 24.29±80.90msec, P=NS). For interventricular dyssynchrony were A: 46.44±19.76msec vs. B: 42.20±29.56msec; A: 45.33±45.67msec vs. B: 29.80±44.66msec; A: 46,38±20 msec vs. B: 21±27.20msec, P=NS) at 48h, 5 and 48 months, respectively. CONCLUSION Apical site of stimulation does not increase ventricular dyssynchrony rate in patients with preserved ejection fraction. Septal stimulation showed decreased trend in interventricular dyssynchrony.
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Affiliation(s)
- Juan Manuel Lange
- Residencia de Cardiología Clínica, Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Corrientes, Argentina.
| | - Hector Manzolillo
- Departamento de Cardiología y Electro Fisiología, Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Corrientes, Argentina
| | - Jorge Parras
- Departamentos de Cardiología y Ecocardiografía, Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Corrientes, Argentina
| | - Domingo Pozzer
- Departamento de Cardiología y Electro Fisiología, Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Corrientes, Argentina
| | - Ignacio Reyes
- Departamento de Cardiología y Electro Fisiología, Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Corrientes, Argentina
| | - Rolando Pantich
- Departamento de Cardiología y Electro Fisiología, Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Corrientes, Argentina
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