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Nabeta T, Galloo X, Tops L, Stassen J, Marsan NA, van der Bijl P, Bax JJ. Significant Mitral Regurgitation After Permanent Right Ventricular Pacemaker Implantation: Prognostic Implications. Am J Cardiol 2024; 222:78-86. [PMID: 38723856 DOI: 10.1016/j.amjcard.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/23/2024]
Abstract
The underlying mechanisms leading to the development of mitral regurgitation (MR) after right ventricular (RV) pacemaker (PM) implantation and its prognostic value have yet to be fully understood. The purpose of this study was to evaluate the prevalence and clinical variables associated with the development of MR after RV pacing and its association with outcomes. A total of 451 patients (mean age 69 ± 15 years, 61% male) who underwent de novo RV PM implantation were included. The development of significant MR, defined as ≥moderate from mild or none/trace at baseline, occurred in 131 (29%) patients at a median of 2.4 years (interquartile range: 1.0 to 3.8 years) after PM implantation. Multivariate logistic regression analysis demonstrated that implantation of a single-chamber PM, left ventricular end-systolic volume index, and the presence of mild MR (vs no MR) at baseline were independently associated with the development of significant MR post-implant. Cardiac events, defined as the composite of all-cause mortality or heart failure hospitalization, occurred in 143 patients (31.7%) during a median follow-up of 5.4 years (interquartile range: 3.0 to 8.1 years). Multivariate Cox regression analysis demonstrated that the development of significant MR was independently related to the occurrence of cardiac events. In conclusion, the development of significant MR after PM implantation is seen in about one-third of recipients and is independently associated with adverse cardiac events.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurens Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Centre, University of Turku and Turku University Hospital, Turku, Finland
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Okafor J, Vazir A, Haldar S, Khattar R. Torrential mitral regurgitation following right ventricular apical pacing in rheumatic mitral valve disease: a case report. Eur Heart J Case Rep 2023; 7:ytad380. [PMID: 37637090 PMCID: PMC10456209 DOI: 10.1093/ehjcr/ytad380] [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: 07/07/2022] [Revised: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
Background Mitral regurgitation may develop or worsen following right ventricular apical pacing due to dyssynchronous left ventricular contraction. Pre-existing secondary mitral annular dilation is a well-recognized and important contributing factor. This description of pacing-induced torrential mitral regurgitation in the setting of rheumatic mitral valve disease is a rare case in which a primary mitral valve lesion was the antecedent mechanism. Case summary A 60-year-old man was admitted with dizziness and pre-syncope. Twelve-lead electrocardiogram showed complete heart block. A dual-chamber pacemaker was implanted and programmed in DDD mode. Transthoracic echocardiography performed a day later demonstrated a left ventricular ejection fraction (LVEF) of 63% and moderate mitral regurgitation. The patient presented 4 months later with breathlessness and orthopnoea. Pacemaker interrogation demonstrated a 98% right ventricular pacing burden. Echocardiography revealed torrential mitral regurgitation secondary to left ventricular dyssynchrony and complete loss of leaflet coaptation with preserved systolic function. Post-capillary pulmonary hypertension was diagnosed following right heart catheterization. The patient underwent metallic mitral valve replacement, tricuspid annuloplasty, and left internal mammary artery grafting to the left anterior descending artery for a severe proximal stenosis. On inspection, the native mitral valve was notably rheumatic in appearance, and this was confirmed histologically. Discussion It is important to closely monitor the progression of mitral regurgitation in those with primary mitral valve disease undergoing right ventricular pacing. Early follow-up may prevent the adverse haemodynamic consequences of worsening mitral regurgitation, with a greater chance of recovery of left ventricular function following surgery.
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Affiliation(s)
- Joseph Okafor
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London, SW3 6LY London, UK
| | - Ali Vazir
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London, SW3 6LY London, UK
| | - Shouvik Haldar
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London, SW3 6LY London, UK
| | - Rajdeep Khattar
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London, SW3 6LY London, UK
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Blessberger H, Kammler J, Kellermair J, Kiblboeck D, Nahler A, Hrncic D, Saleh K, Schwarz S, Reiter C, Fellner A, Eppacher C, Sheldon TJ, Steinwender C. Impact of pacing mode and different echocardiographic parameters on cardiac output (PADIAC). Front Cardiovasc Med 2023; 10:1185518. [PMID: 37265566 PMCID: PMC10231674 DOI: 10.3389/fcvm.2023.1185518] [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: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction The extent of the hemodynamic benefit from AV-synchronous pacing in patients with sinus rhythm and AV block is not completely understood. Thus, we systematically investigated the association of an array of echocardiographic and epidemiological parameters with the change in cardiac output depending on the stimulation mode (AV-synchronous or AV-asynchronous pacing). Methods Patients in sinus rhythm after previous dual chamber pacemaker implantation underwent a thorough basic echocardiographic assessment of diastolic and systolic left ventricular function, and atrial function (26 echo parameters, including novel speckle tracking strain measurements). Then, stroke volume was measured with AV-synchronous (DDD) and AV-asynchronous (VVI) pacing. Each patient represented their own control, and the sequence of stroke volume measurements was randomized. Results In this prospective single-center study (NCT04068233, registration August 22nd 2019), we recruited 40 individuals. The stroke volume was higher in all patients when applying AV-synchronous DDD pacing [median increase 12.8 ml (16.9%), P < 0.001]. No echo parameter under investigation was associated with the extent of stroke volume increase in a linear regression model. Of all epidemiological variables, a history of acute myocardial infarction (AMI) was associated with an attenuated stroke volume gain in a univariate and a multivariate regression model that adjusted for confounders. A- and S-wave velocities were reduced in the AMI group. Discussion In our cohort of patients, each subject benefited from AV-synchronous DDD pacing. No single echo parameter could predict the amount of stroke volume increase. The beneficial effect of AV-synchronous pacing on stroke volume was attenuated after prior acute myocardial infarction.ClinicalTrials.gov identifier (NCT number): NCT04068233.
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Affiliation(s)
- Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Juergen Kammler
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Joerg Kellermair
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Daniel Kiblboeck
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Alexander Nahler
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Denis Hrncic
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Karim Saleh
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Stefan Schwarz
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Alexander Fellner
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | | | | | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
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El Diasty M, Davies M, Fernandez AL, Ribeiro I, Payne D, Petsikas D. Does Pacemaker Implantation After Surgical Aortic Valve Replacement Impact Long-Term Morbidity and Mortality? A Focused Review. Tex Heart Inst J 2022; 49:487617. [PMID: 36252278 PMCID: PMC9632401 DOI: 10.14503/thij-20-7518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Permanent pacing remains a serious complication that can occur in the postoperative period of surgical aortic valve replacement. The reported incidence is variable, and there are many perioperative factors that have been linked with a greater need for permanent pacing. Permanent pacing can also be associated with late lead-related and cardiac complications that can affect late outcome. However, the degree of late dependence on pacemakers is varied, and some studies have shown that a substantial proportion of patients do not need long-term pacing. Some groups have found that permanent pacing was associated with a negative impact on long-term survival in these patients. A common finding among these studies is that the groups of patients with pacemakers had higher preoperative surgical risk and comorbidity status. This makes it difficult to establish whether permanent pacing on its own represents a risk factor for late mortality or whether it is simply a marker that reflects the higher complexity and comorbidities in this group of patients.
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Affiliation(s)
- Mohammad El Diasty
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Mark Davies
- Cardiology Department, Oxford University Hospital, Oxford, United Kingdom
| | - Angel L. Fernandez
- Cardiovascular Surgery Department, University Hospital, Santiago de Compostela, Spain
| | - Igo Ribeiro
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Darrin Payne
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Dimitri Petsikas
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
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Servito M, Khoury W, Payne D, Baranchuk A, El Diasty M. Long-term impact of permanent cardiac pacing after surgical aortic valve replacement: systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2022; 20:81-86. [DOI: 10.1080/14779072.2022.2031981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria Servito
- Faculty of Medicine, Queen’s University, Kingston, ON, Canada
| | - William Khoury
- Faculty of Medicine, Queen’s University, Kingston, ON, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Mohammad El Diasty
- Division of Cardiac Surgery, Kingston Health Sciences Centre, Kingston, ON, Canada
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Ma PP, Yang YH, Dai BL, Zhang RF, Wang N, Li DN, Yin XM, Gao LJ, Xia YL, Yang YZ, Dong YX. Brady-arrhythmias in patients with atrial fibrillation and heart failure of reduced ejection fraction: is his-bundle pacing superior to biventricular pacing?. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1193-1199. [PMID: 34080696 DOI: 10.1111/pace.14289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of His-bundle pacing (HBP) compared with the traditional biventricular pacing (BVP) on patients with brady-arrhythmias, who suffer from permanent atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). METHODS All patients with brady-arrhythmias, permanent AF and HFrEF were continuously enrolled from January 2017 to July 2019 and followed up for at least 12 months. The differences in QRS duration (QRSd), New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), tricuspid regurgitation grade, mitral regurgitation grade, left ventricular end-diastolic diameter (LVEDD), and left atrial size were compared. RESULTS A total of 52 patients were enrolled: 37 patients were with HBP and 15 patients with BVP. There was no electrode dislodged, perforation, infection or thrombosis during the follow-up of 18.12 ± 4.45 months. The success rate for HBP implantation was 88.10%. The capture threshold of his-bundle and the threshold of the left ventricular lead remained stable during follow-up. LVEF increased to higher than 50% in 11 patients with HBP (29.73%). The NYHA classification (both p < .001), LVEF (both p < .001) and LVEDD improved significantly during the follow-up in both groups. NYHA (p = .030), LVEF (p = .013), and LVEDD (p = .003) improved in patients with HBP compared with BVP. CONCLUSION HBP was safe and more effective in improving the cardiac function and remodeling in patients with brady-arrhythmias, permanent AF and HFrEF compared with BVP.
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Affiliation(s)
- Pei-Pei Ma
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yi-Heng Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Bai-Ling Dai
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Rong-Feng Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Nan Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Dan-Na Li
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiao-Meng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lian-Jun Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yun-Long Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yan-Zong Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ying-Xue Dong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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A Case of Severe Mitral Valve Regurgitation in a Patient with Leadless Pacemaker. Case Rep Cardiol 2020; 2020:5389279. [PMID: 32665866 PMCID: PMC7346111 DOI: 10.1155/2020/5389279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022] Open
Abstract
An 85-year-old man with cardiac history notable for atrial fibrillation diagnosed 10 years ago which was being treated with atenolol and warfarin presented to our institution with persistent atrial fibrillation. His echocardiogram showed ejection fraction (EF) of 56%, no regional wall motion abnormalities, mild mitral and pulmonary regurgitation, and trivial tricuspid regurgitation. Despite this treatment, he had recurrent episodes of paroxysmal symptomatic atrial fibrillation with a rapid rate requiring multiple emergency department visits and hospital admissions. Given difficulty to control the rate, he underwent atrioventricular (AV) nodal ablation and leadless pacemaker insertion. Fifteen days after the procedure, he was found to have a severe mitral regurgitation murmur.
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Permanent HIS bundle Pacing Feasibility in Routine Clinical Practice: Experience from an Indian Center. Indian Heart J 2019; 71:360-363. [PMID: 31779867 PMCID: PMC6890947 DOI: 10.1016/j.ihj.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/22/2019] [Accepted: 09/01/2019] [Indexed: 11/24/2022] Open
Abstract
There is a paucity of experience regarding His bundle pacing (HBP) at laboratories initially attempting the procedure, especially in the Indian scenario. Patient who underwent HBP were selected for pacing therapy or in lieu of cardiac resynchronization therapy (CRT) at a single center. Among 22 patients attempted, 19 patients underwent successful implant, achieving selective HBP in 14 patients. There was a significant improvement in left ventricular ejection fraction (LVEF) (49.3 ± 9.3 vs. 36.7 ± 9.2) in the LV dysfunction subgroup (n = 6). Over a follow-up of 15 ± 6.5 months, thresholds were stable in all except one patient, and there was no requirement of lead revision. In summary, we found that HBP is a feasible option for achieving physiological pacing.
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Cronin B, Danforth D, Pollema T, Maus T. Ventricular Pacing-Induced Tricuspid Regurgitation After Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2019; 34:851-853. [PMID: 31500978 DOI: 10.1053/j.jvca.2019.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Brett Cronin
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
| | - Dennis Danforth
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
| | - Travis Pollema
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
| | - Timothy Maus
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
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Prior Pacemaker Implantation and Clinical Outcomes in Patients With Heart Failure and Preserved Ejection Fraction. JACC-HEART FAILURE 2019; 7:418-427. [DOI: 10.1016/j.jchf.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 12/01/2018] [Indexed: 11/19/2022]
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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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Sohn SH, Hwang HY. Permanent pacemaker implantation is never a benign complication after aortic valve replacement. J Thorac Dis 2018; 10:S4080-S4081. [PMID: 30631560 DOI: 10.21037/jtd.2018.09.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Ricciardi G, Checchi L. Permanent his bundle pacing: A physiological alternative to conventional right ventricular pacing or just a futile artifice? Int J Cardiol 2018; 260:107-108. [PMID: 29622418 DOI: 10.1016/j.ijcard.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Giuseppe Ricciardi
- Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy.
| | - Luca Checchi
- Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
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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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Motwani SK, Datt V, Tempe DK. Severe Mitral Regurgitation Due to Pacing in Patient Post Aortic Valve Replacement (A Case Report). ACTA ACUST UNITED AC 2018. [DOI: 10.4236/wjcs.2018.81003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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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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Honing in on optimal ventricular pacing sites: an argument for his bundle pacing. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:372. [PMID: 25778424 DOI: 10.1007/s11936-015-0372-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OPINION STATEMENT Frequent ventricular pacing is often or completely unavoidable in patients with high-grade or complete heart block. Over time, patients with high-burden RV pacing are at risk for developing symptomatic cardiomyopathy due to pacing-induced ventricular dyssynchrony. Growing awareness of this concern has generated interest in alternative pacing sites like the septum and outflow tract, the thinking being that these sites will more closely mimic His-Purkinje-mediated ventricular activation. Numerous studies have met with mixed results likely due to the fact that-to quote Marvin Gaye-there ain't nothing like the real thing. Herein lies the advantage of His bundle pacing (HBP), as it is the only pacing modality capable of physiological ventricular activation. HBP has been demonstrated to be safe and reliable in various forms of AV block with minimal drawbacks, namely modestly higher pacing thresholds when compared with other RV sites. Additionally, HBP is a truly physiologic alternative to biventricular pacing to effect cardiac resynchronization therapy (CRT), a concept supported by small observational and prospective studies. In our view, His bundle pacing should be considered in nearly all patients requiring ventricular pacing.
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Andrikopoulos G, Tzeis S, Asbach S, Semmler V, Lennerz C, Solzbach U, Grebmer C, Kloppe A, Klein N, Pastromas S, Biermann J, Kolb C. A stepwise electrocardiographic algorithm for differentiation of mid-septal vs. apical right ventricular lead positioning: the SPICE ECG substudy. Europace 2015; 17:915-20. [DOI: 10.1093/europace/euu344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/06/2014] [Indexed: 01/29/2023] Open
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Guglin M, Barold SS. The role of biventricular pacing in the prevention and therapy of pacemaker-induced cardiomyopathy. Ann Noninvasive Electrocardiol 2015; 20:224-39. [PMID: 25564929 DOI: 10.1111/anec.12245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Right ventricular (RV) pacing produces well-known long-term deleterious effects not only on already compromised, but also on the normal left ventricle (LV). The activation pattern mimicks that of left bundle branch block, with delayed activation of the LV free wall, and results in electrical and mechanical dyssynchrony. Long-term mandatory (100%) RV pacing, increases LV dimensions and decreases the ejection fraction. Many of these negative effects of pacing can be overcome by biventricular pacing. In this review, we describe the characteristics of pacemaker-induced cardiomyopathy, its incidence, and the use of cardiac resynchronization therapy (CRT) for its therapy and prevention. The gaps in the current organizational guidelines for using CRT in the treatment of bradycardia are identified, and goals for future research are discussed.
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Affiliation(s)
| | - S Serge Barold
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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Ferrari ADL, Borges AP, Albuquerque LC, Pelzer Sussenbach C, Rosa PRD, Piantá RM, Wiehe M, Goldani MA. Cardiomyopathy induced by artificial cardiac pacing: myth or reality sustained by evidence? Braz J Cardiovasc Surg 2014; 29:402-13. [PMID: 25372916 PMCID: PMC4412332 DOI: 10.5935/1678-9741.20140104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/05/2014] [Indexed: 01/27/2023] Open
Abstract
Implantable cardiac pacing systems are a safe and effective treatment for symptomatic
irreversible bradycardia. Under the proper indications, cardiac pacing might bring
significant clinical benefit. Evidences from literature state that the action of the
artificial pacing system, mainly when the ventricular lead is located at the apex of
the right ventricle, produces negative effects to cardiac structure (remodeling,
dilatation) and function (dissinchrony). Patients with previously compromised left
ventricular function would benefit the least with conventional right ventricle apical
pacing, and are exposed to the risk of developing higher incidence of morbidity and
mortality for heart failure. However, after almost 6 decades of cardiac pacing, just
a reduced portion of patients in general would develop these alterations. In this
context, there are not completely clear some issues related to cardiac pacing and the
development of this cardiomyopathy. Causality relationships among QRS widening with a
left bundle branch block morphology, contractility alterations within the left
ventricle, and certain substrates or clinical (previous systolic dysfunction,
structural heart disease, time from implant) or electrical conditions (QRS duration,
percentage of ventricular stimulation) are still subjecte of debate. This review
analyses contemporary data regarding this new entity, and discusses alternatives of
how to use cardiac pacing in this context, emphasizing cardiac resynchronization
therapy.
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Affiliation(s)
| | - Anibal Pires Borges
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | - Mario Wiehe
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marco Antônio Goldani
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Akerström F, Pachón M, Puchol A, Jiménez-López J, Segovia D, Rodríguez-Padial L, Arias MA. Chronic right ventricular apical pacing: adverse effects and current therapeutic strategies to minimize them. Int J Cardiol 2014; 173:351-60. [PMID: 24721486 DOI: 10.1016/j.ijcard.2014.03.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023]
Abstract
The permanent cardiac pacemaker is the only effective therapy for patients with symptomatic bradycardia and hundreds of millions are implanted worldwide every year. Despite its undisputed clinical benefits, the last two decades have drawn much attention to the negative effects associated with long-term pacing of the right ventricle (RV). Experimental and clinical studies have shown that RV pacing produces ventricular dyssynchrony, similar to that of left bundle branch block, with consequent detrimental effects on cardiac structure and function, with adverse clinical outcomes such as atrial fibrillation, heart failure and death. Although clinical evidence largely comes from subanalyses of pacemaker and implantable cardiac defibrillator studies, there is strong evidence that patients with reduced left ventricular function are at high risk of suffering from the detrimental effects of long-term RV pacing. Biventricular pacing in cardiac resynchronization therapy devices can prevent ventricular dyssynchrony and has emerged as an attractive option in this patient group with promising results and more clinical studies underway. Moreover, there is evidence that specific pacemaker algorithms that minimize RV pacing can reduce the negative effects of RV stimulation on cardiac function and may also prevent clinical deterioration. The extent of the long-term clinical effects of RV pacing in patients with normal ventricular function and how to prevent this are less clear and subject to future investigation.
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Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Marta Pachón
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Jesús Jiménez-López
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Diana Segovia
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Luis Rodríguez-Padial
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
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23
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Development of mitral and tricuspid regurgitation in right ventricular apex versus right ventricular outflow tract pacing. J Interv Card Electrophysiol 2014; 40:81-6. [DOI: 10.1007/s10840-014-9878-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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Kronborg MB, Mortensen PT, Poulsen SH, Gerdes JC, Jensen HK, Nielsen JC. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace 2014; 16:1189-96. [DOI: 10.1093/europace/euu011] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Elder DHJ, Lang CC, Choy AM. Pacing-induced heart disease: understanding the pathophysiology and improving outcomes. Expert Rev Cardiovasc Ther 2014; 9:877-86. [DOI: 10.1586/erc.11.82] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Catanzariti D, Maines M, Manica A, Angheben C, Varbaro A, Vergara G. Permanent His-bundle pacing maintains long-term ventricular synchrony and left ventricular performance, unlike conventional right ventricular apical pacing. Europace 2012; 15:546-53. [PMID: 22997222 DOI: 10.1093/europace/eus313] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Right ventricular apical pacing (RVAP) may be deleterious, determining abnormal left ventricular (LV) electrical activation and progressive LV dysfunction. Permanent His-bundle pacing (HBP) has been proposed to prevent this detrimental effect. The aim of our study was to compare the long-term effects of HBP on LV synchrony and systolic performance with those of RVAP in the same group of patients. METHODS Our analysis included 26 patients who received both an HBP lead and an RVAP lead, as backup, in our electrophysiology laboratory between 2004 and 2007. After implantation, all devices were programmed to obtain HBP. An intra-patient comparison of the effects of HBP and RVAP on LV dyssynchrony and function was performed at the last available follow-up examination. RESULTS After a mean of 34.6 ± 11 months, the pacing modality was temporarily switched to RVAP. During RVAP, LV ejection fraction significantly decreased (50.1 ± 8.8% vs. 57.3 ± 8.5%, P < 0.001), mitral regurgitation significantly increased (22.5 ± 10.9% vs.16.3 ± 12.4%; P = 0.018), and inter-ventricular delay significantly worsened (33.4 ± 19.5 ms vs. 7.1 ± 4.7 ms, P = 0.003) in comparison with HBP. However, the myocardial performance index was not statistically different between the two pacing modalities (P = 0.779). No asynchrony was revealed by tissue Doppler imaging during HBP, while during RVAP the asynchrony index was significantly higher in both the four-chamber (125.8 ± 63.9 ms; P = 0.035 vs. HBP) and two-chamber (126 ± 86.5 ms; P = 0.037 vs. HBP) apical views. CONCLUSION His-bundle pacing has long-term positive effects on inter- and intra-ventricular synchrony and ventricular contractile performance in comparison with RVAP. It prevents asynchronous pacing-induced LV ejection fraction depression and mitral regurgitation.
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Abstract
The right ventricular (RV) apex has been the standard pacing site since the development of implantable pacemaker technology. Although RV pacing was initially only utilized for the treatment of severe bradyarrhythmias usually due to complete heart block, today the indications for and implantation of RV pacing devices is dramatically larger. Recently, the adverse effects of chronic RV apical pacing have been described including an increased risk of heart failure and death. This review details the detrimental effects of RV apical pacing and their shared hemodynamic pathophysiology. In particular, the role of RV apical pacing induced ventricular dyssynchrony is highlighted with a specific focus on differential outcome based upon QRS morphology at implant.
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Affiliation(s)
- Andrew Brenyo
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
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Choi BJ, Cho KI, Kim SM, Song YJ, Lee HG, Kim TI. Impact of right ventricular apical pacing and its frequency on left atrial function. J Cardiovasc Ultrasound 2012; 20:42-8. [PMID: 22509438 PMCID: PMC3324727 DOI: 10.4250/jcu.2012.20.1.42] [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] [Received: 12/27/2011] [Revised: 02/14/2012] [Accepted: 02/16/2012] [Indexed: 12/29/2022] Open
Abstract
Background Right ventricular apical (RVA) pacing induces left ventricular (LV) dyssynchrony, increases the risk of persistent atrial fibrillation in the long term. The aim was to investigate the effects of RVA pacing on left atrial (LA) function, which are unknown. Methods Echocardiographic evaluation including LV dyssynchrony based on conventional Doppler, tissue Doppler imaging and speckle tracking strain echocardiography was done before and after (12 months) single-chamber ventricular pacemaker implantation in 40 patients with sick sinus syndrome. Patients were divided to 2 groups, according to the RVA pacing frequency (group I had higher pacing rate of more than 50% and group II, less than 50%). Results There was no significant difference in LV ejection fraction, however, mean global LV strain, myocardial performance index, and parameters of LV dyssynchrony had shown significant changes after 12 months of RVA pacing. There were also significant increase in the LA volume index and the reduction of peak systolic LA strain and strain rate (SR), peak early and late diastolic SR after RVA pacing. Moreover, there was significant deterioration of LV dyssynchrony and both LA and LV longitudinal function in even group II. LA functional deterioration and LA volume was significantly correlated with the frequency of RVA pacing. Conclusion LV dyssynchrony, induced by RVA pacing, significantly impaired active LA contraction and passive stretching, and these findings were shown in the patients with even less than 50% of RVA pacing. Impairment of LA strain/SR was significantly correlated with the frequency of RVA pacing.
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Affiliation(s)
- Byung-Joo Choi
- Division of Cardiology, Department of Internal Medicine, Ulsan Hospital, Ulsan, Korea
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29
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Barba-Pichardo R, Moriña-Vázquez P, Fernández-Gómez JM, Venegas-Gamero J, Herrera-Carranza M. Permanent His-bundle pacing: seeking physiological ventricular pacing. Europace 2010; 12:527-33. [PMID: 20338988 DOI: 10.1093/europace/euq038] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Right ventricular apical pacing can have deleterious effects and the His bundle has been widely reported to be an alternative site. This paper presents our experience with permanent His-bundle pacing (HBP). METHODS AND RESULTS Patients referred for pacemaker implants (regardless of block type) were screened to determine if temporary HBP corrected conduction dysfunctions (threshold < or =2.5 V for 1 ms) and provided infra-Hisian 1:1 conduction of at least 120 s/m. Of the 182 patients selected, HBP corrected conduction dysfunctions in 133 (73%) patients, 42 (32%) of whom were rejected for the permanent procedure due to high thresholds. His-bundle lead implantation was attempted in the remaining 91 patients and was successful in 59 (65% of all attempts, 44% of all possible cases). CONCLUSION In some patients, permanent HBP may be an alternative to right ventricular apical pacing.
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Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol 2009; 54:764-76. [PMID: 19695453 DOI: 10.1016/j.jacc.2009.06.006] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
Cardiac pacing is the only effective treatment for patients with sick sinus syndrome and atrioventricular conduction disorders. In cardiac pacing, the endocardial pacing lead is typically positioned at the right ventricular (RV) apex. At the same time, there is increasing indirect evidence, derived from large pacing mode selection trials and observational studies, that conventional RV apical pacing may have detrimental effects on cardiac structure and left ventricular function, which are associated with the development of heart failure. These detrimental effects may be related to the abnormal electrical and mechanical activation pattern of the ventricles (or ventricular dyssynchrony) caused by RV apical pacing. Still, it remains uncertain if the deterioration of left ventricular function as noted in a proportion of patients receiving RV apical pacing is directly related to acutely induced left ventricular dyssynchrony. The upgrade from RV pacing to cardiac resynchronization therapy may partially reverse the deleterious effects of RV pacing. It has even been suggested that selected patients with a conventional pacemaker indication should receive cardiac resynchronization therapy to avoid the deleterious effects. This review will provide a contemporary overview of the available evidence on the detrimental effects of RV apical pacing. Furthermore, the available alternatives for patients with a standard pacemaker indication will be discussed. In particular, the role of cardiac resynchronization therapy and alternative RV pacing sites in these patients will be reviewed.
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Affiliation(s)
- Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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31
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Muto C, Ascione L, Canciello M, Carreras G, Iengo R, Ottaviano L, Calvanese R, Accadia M, Celentano E, Ciardiello C, Tuccillo B. Effect of right ventricular apical pacing in survivors of myocardial infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S173-6. [PMID: 19250087 DOI: 10.1111/j.1540-8159.2008.02279.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Much information is available regarding the possible negative effects of long-term right ventricular (RV) apical pacing, which may cause worsening of heart failure. However, very limited data are available regarding the effects of RV pacing in patients with a previous myocardial infarction (MI). METHODS AND RESULTS We screened 115 consecutive post-MI patients and matched a group of 29 pacemaker (PM) recipients with a group of 49 unpaced patients, for age, left ventricular (LV) ejection fraction, and site of MI. During a median follow-up of 54 months, echocardiograms showed a decrease in LV ejection fraction in the paced group, from 51 +/- 10 to 39 +/- 11 (P < 0.01), and a minimal change in the unpaced group, from 57 +/- 8 to 56 +/- 7 (P = 0.98). Similar change was observed in systolic and diastolic diameters and volumes. CONCLUSIONS The study showed that, in post-MI patients, RV apical pacing was associated with a worsening of LV function, suggesting that, among MI survivors, the need for a PM is a marker of worse outcome.
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Affiliation(s)
- Carmine Muto
- Electrophysiology and Echocardiography, Department of Cardiology, S.M. Loreto Mare Hospital, Naples, Italy.
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Martínez Ferrer J, Fidalgo Andrés ML, Barba Pichardo R, Sancho-Tello de Carranza MJ. Novedades en estimulación cardiaca. Rev Esp Cardiol (Engl Ed) 2009; 62 Suppl 1:117-28. [DOI: 10.1016/s0300-8932(09)70046-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Faber L, Lamp B. Mitral valve regurgitation and left ventricular systolic dysfunction: corrective surgery or cardiac resynchronization therapy? Herzschrittmacherther Elektrophysiol 2008; 19 Suppl 1:52-59. [PMID: 19169735 DOI: 10.1007/s00399-008-0602-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congestive heart failure (CHF) and systolic left ventricular (LV) dysfunction despite a structurally normal valve. This functional or secondary regurgitation results from a dysbalance between closing and opening forces on the mitral leaflets due to reduced LV contractility, geometric distortion of the subvalvular apparatus, and global dilatation of the left ventricle and the mitral annulus. MR in LV dysfunction has a negative impact on both symptoms and prognosis. Surgical correction of secondary MR remained controversial although it was found to be technically feasible and to provide symptomatic benefit in some (mostly) mono-center series. Cardiac resynchronization therapy (CRT) was also found to improve secondary mitral regurgitation. However, the prediction in which patient significant secondary MR will improve with CRT is largely unresolved. The following paper reviews the available data concerning the two major interventional options for significant secondary MR in patients with CHF and systolic LV dysfunction, i.e. mitral valve surgery vs. CRT, and describes our institutional approach to this problem.
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Affiliation(s)
- L Faber
- Department of Cardiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
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Barba-Pichardo R, Moriña-Vázquez P, Venegas-Gamero J, Frutos-López M, Moreno-Lozano V, Herrera-Carranza M. Posibilidades y realidades de la estimulación permanente del haz de His. Rev Esp Cardiol 2008. [DOI: 10.1157/13126051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Catanzariti D, Maines M, Cemin C, Broso G, Marotta T, Vergara G. Permanent direct his bundle pacing does not induce ventricular dyssynchrony unlike conventional right ventricular apical pacing. An intrapatient acute comparison study. J Interv Card Electrophysiol 2006; 16:81-92. [PMID: 17115267 DOI: 10.1007/s10840-006-9033-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 07/10/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND Benefits of A-V synchrony during right ventricular apical pacing are neutralized by induction of ventricular dyssynchrony. Only a few data are reported about direct His bundle pacing influence on ventricular synchronism. AIM Was to assess the capability of direct His bundle pacing to prevent pacing-induced ventricular dyssynchrony comparing DDD- (or VVI- in case of Atrial Fibrillation) right ventricular apical pacing with DDD- (or VVI-) direct His bundle pacing in the same patients cohort. METHODS 23 of 24 patients (mean age 75.1 +/- 6.4 years) with narrow QRS (HV < 65 ms) underwent permanent direct His bundle pacing for "brady-tachy syndrome" (11) or supra-Hisian II/III-degree AV Block (permanent atrial fibrillation 7, AV Node ablation 1). A 4.1 F screw-in lead was fixed in His position, guided by endocardial pacemapping and unipolar recordings. Additional permanent (13 patients) or temporary right ventricular apical pacing leads were also positioned. Inter- and left intra-ventricular dyssynchrony, mitral regurgitation and left systolic ventricular function Tei index were assessed during either direct His bundle pacing or right ventricular apical pacing. RESULTS Permanent direct His bundle pacing was obtained in 23 of 24 patients. Indexes of ventricular dyssynchrony were drastically reduced, mitral regurgitation decreased and left systolic ventricular function Tei index improved during direct His bundle pacing (or His bundle and septum pacing) in comparison to apical pacing (p < 0.05). No statistically significant differences were observed between direct His bundle pacing and combined His bundle and septum pacing. CONCLUSION Direct His bundle pacing (also fused with adjacent septum capture) prevents pacing-induced ventricular dyssynchrony.
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Affiliation(s)
- Domenico Catanzariti
- Divisione di Cardiologia, Ospedale S. Maria del Carmine, Corso Verona, n. 4, 38068, Rovereto, TN, Italy.
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Barold SS, Lau CP. Primary Prevention of Heart Failure in Cardiac Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:217-9. [PMID: 16606386 DOI: 10.1111/j.1540-8159.2006.00325.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ovsyshcher IE. The search for optimal atrioventricular interval. J Interv Card Electrophysiol 2005; 14:95-8. [PMID: 16374556 DOI: 10.1007/s10840-005-4514-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 08/22/2005] [Indexed: 01/01/2023]
Affiliation(s)
- I Eli Ovsyshcher
- Electrophysiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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