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Ghossein MA, Salden FCWM, Van Stipdonk AMW, Janssen B, Luermans JGLM, Westra S, Prinzen FW, Vernooy K. Endocardial pacing results in better electrical resynchronization and hemodynamic improvement than epicardial pacing in CRT. Europace 2022. [DOI: 10.1093/europace/euac053.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The original study was financially supported by Medtronic (Minneapolis, Minnesota). The investigation of the current abstract is unrelated to the original financial support.
Background
Cardiac resynchronization therapy (CRT) is conventionally applied by means of a transvenous epicardial left ventricular (LV) lead. Studies suggest that endocardial LV pacing may result in better resynchronization and LV function than epicardial LV pacing.
Purpose
To investigate whether endocardial pacing results in better electrical resynchronization and hemodynamic improvement compared to epicardial pacing.
Methods
Patients with an indication for CRT were prospectively included from two hospitals. In all patients, LV pacing was performed endocardially and epicardially in the postero-lateral region. QRS area was calculated from vectorcardiograms that were synthesized from 12-lead ECGs. Acute hemodynamic improvement was assessed as the change in maximum rate of rise of LV-pressure (%ΔLVdP/dtmax). We assessed the effects of endocardial and epicardial LV pacing on the change in QRS area (∆QRS area) and LVdP/dtmax (%ΔLVdP/dtmax).
Results
A total of 16 patients (age 66 ± 11 years, 56% male, 31% ischemic cardiomyopathy, QRS duration 166±18ms, LBBB in 88%) were included. Endocardial pacing resulted in greater ∆QRS area than epicardial pacing (-51 ± 34 µVs vs. -24 ± 37 µVs, p = 0.021, Panel A). In addition, endocardial pacing led to a larger %ΔLVdP/dtmax as compared to epicardial pacing (21 ± 12% vs. 18 ± 9%, p = 0.025, Panel B).
Conclusion
Compared to conventional epicardial LV pacing in CRT, endocardial LV pacing results in better electrical resynchronization and acute hemodynamic improvement.
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Affiliation(s)
- MA Ghossein
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - FCWM Salden
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - AMW Van Stipdonk
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - B Janssen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - JGLM Luermans
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - S Westra
- University Medical Center St Radboud (UMCN), Cardiology, Nijmegen, Netherlands (The)
| | - FW Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
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Salden FCWM, Prinzen FW, Lumens J, Vernooy K. Atrioventricular dromotropathy: an important substrate for complete resynchronization therapy-Authors' reply. Europace 2022; 24:868-869. [PMID: 35352810 PMCID: PMC9071079 DOI: 10.1093/europace/euac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Floor C W M Salden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Joost Lumens
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Salden FCWM, Huntjens PR, Schreurs R, Willemen E, Kuiper M, Wouters P, Maessen JG, Bordachar P, Delhaas T, Luermans J, Meine M, Allaart CP, van Stipdonk AMW, Prinzen FW, Lumens J, Vernooy K. Pacing therapy for atrioventricular dromotropathy: a combined computational-experimental-clinical study. Europace 2021; 24:784-795. [PMID: 34718532 PMCID: PMC9071072 DOI: 10.1093/europace/euab248] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/11/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Investigate haemodynamic effects, and their mechanisms, of restoring atrioventricular (AV)-coupling using pacemaker therapy in normal and failing hearts in a combined computational-experimental-clinical study. METHODS AND RESULTS Computer simulations were performed in the CircAdapt model of the normal and failing human heart and circulation. Experiments were performed in a porcine model of AV dromotropathy. In a proof-of-principle clinical study, left ventricular (LV) pressure and volume were measured in 22 heart failure (HF) patients (LV ejection fraction <35%) with prolonged PR interval (>230 ms) and narrow or non-left bundle branch block QRS complex. Computer simulations and animal studies in normal hearts showed that restoring of AV-coupling with unchanged ventricular activation sequence significantly increased LV filling, mean arterial pressure, and cardiac output by 10-15%. In computer simulations of failing hearts and in HF patients, reducing PR interval by biventricular (BiV) pacing (patients: from 300 ± 61 to 137 ± 30 ms) resulted in significant increases in LV stroke volume and stroke work (patients: 34 ± 40% and 26 ± 31%, respectively). However, worsening of ventricular dyssynchrony by using right ventricular (RV) pacing abrogated the benefit of restoring AV-coupling. In model simulations, animals and patients, the increase of LV filling and associated improvement of LV pump function coincided with both larger mitral inflow (E- and A-wave area) and reduction of diastolic mitral regurgitation. CONCLUSION Restoration of AV-coupling by BiV pacing in normal and failing hearts with prolonged AV conduction leads to considerable haemodynamic improvement. These results indicate that BiV or physiological pacing, but not RV pacing, may improve cardiac function in patients with HF and prolonged PR interval.
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Affiliation(s)
- Floor C W M Salden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Peter R Huntjens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Rick Schreurs
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Erik Willemen
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Philippe Wouters
- Department of Cardiology, University Medical Centre Utrecht (UMC Utrecht), Utrecht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Pierre Bordachar
- Department of Cardiology, Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht (UMC Utrecht), Utrecht, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam University Medical Centre (Amsterdam UMC), Amsterdam, The Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre (RadboudUMC), Nijmegen, The Netherlands
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Ghossein MA, Van Stipdonk AMW, Salden FCWM, Engels EB, Zanon F, Westra S, Maass AH, Rienstra M, Prinzen FW, Vernooy K. Reduction in QRS area correlates with hemodynamic response during CRT-device implantation. Europace 2021. [DOI: 10.1093/europace/euab116.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background Previous studies have shown that reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome.
Purpose To investigate whether reduction in QRS area is associated with hemodynamic improvement and whether QRS area reduction could be used for CRT optimization, with respect to LV lead position and device programming in individual patients.
Methods A total of 78 patients with indication for CRT were prospectively included in 4 hospitals. QRS area was calculated from vectorcardiograms that were synthesized from 12-lead ECG’s. Acute hemodynamic response was assessed invasively as the maximum rate of percentual left ventricular (LV) pressure (%LVdP/dtmax) rise. QRS area reduction was studied in relation to LV-lead position (n = 26), proximal versus distal LV lead position (n = 27), and VV-delay (n = 25).
Results Combining all measurements in all patients showed a significant correlation between QRS area reduction and %LVdP/dTmax increase (R = 0.49, P < 0.0001). Also, when one fixed routine implantation setting was used for each patient (lateral lead position, distal, AV-delay 120-150ms, VV-delay 0ms) this correlation was present (R = 0.45, p < 0.0001, figure panel A). In 21 patients in which at least 3 lead positions were available there was also a significant correlation between QRS area reduction and %LVdP/dtmax increase (average R = 0.69, p < 0.0001, panel B). For VV-delay, 25 other patients as well showed a significant correlation (average R = 0.53, p < 0.0001).
Conclusion Within patients, QRS area reduction is associated with %LVdP/dtmax increase with various LV lead positions and VV-intervals. Therefore, QRS area, which is an easily obtainable and objective parameter, might be a promising tool for optimization of LV lead position and device programming in CRT. Abstract Figure.
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Affiliation(s)
- MA Ghossein
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - AMW Van Stipdonk
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - FCWM Salden
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - EB Engels
- Yale New Haven Hospital, New Haven, United States of America
| | - F Zanon
- Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - S Westra
- Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - AH Maass
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - M Rienstra
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - FW Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
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Dural M, van Stipdonk AMW, Salden FCWM, Ter Horst I, Crijns HJGM, Meine M, Maass AH, Kloosterman M, Vernooy K. Association of ECG characteristics with clinical and echocardiographic outcome to CRT in a non-LBBB patient population. J Interv Card Electrophysiol 2020; 62:9-19. [PMID: 32918666 DOI: 10.1007/s10840-020-00866-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/04/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited. Additional selection criteria are needed to identify these patients. METHODS Seven hundred ninety consecutive patients with non-LBBB morphology, who received a CRT-device in 3 university centers in the Netherlands, were selected. Pre-implantation 12-lead ECGs were evaluated on morphology, duration, and area of the QRS complex, as well as on PR interval, left ventricular activation time (LVAT), and the presence of fragmented QRS (fQRS). Association of these ECG features with the primary endpoint: a combination of left ventricular assist device (LVAD) implantation, cardiac transplantation and all-cause mortality, and secondary endpoint-echocardiographic reduction of left ventricular end-systolic volume (LVESV)-were evaluated. RESULTS The primary endpoint occurred more often in non-LBBB patients with with PR interval ≥ 230ms, QRS area < 109μVs, and with fQRS. Multivariable regression analysis showed independent associations of QRS area (HR 2.33 [1.44, 3.77], p = 0.001) and PR interval (HR 2.03 [1.51, 2.74], p < 0.001) only. Mean LVESV reduction was significantly lower in patients with baseline RBBB, QRS duration < 150 ms, PR interval ≥ 230 ms, and in QRS area < 109 μVs. Multivariable regression analyses only showed significant associations between QRS area ≥ 109 μVs (OR 2.00 [1.09, 3.66] p = 0.025) and probability of echocardiographic response to CRT. CONCLUSIONS In the heterogeneous non-LBBB patient population, QRS area and PR prolongation rather than traditional QRS duration and morphology are associated to both clinical and echocardiographic outcomes of CRT.
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Affiliation(s)
- Muhammet Dural
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, 26040, Odunpazarı, Eskişehir, Turkey.
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Floor C W M Salden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Iris Ter Horst
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Mariëlle Kloosterman
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Salden FCWM, Luermans JGLM, Westra SW, Weijs B, Engels EB, Heckman LIB, Lamerichs LJM, Janssen MHG, Clerx KJH, Cornelussen R, Ghosh S, Prinzen FW, Vernooy K. Short-Term Hemodynamic and Electrophysiological Effects of Cardiac Resynchronization by Left Ventricular Septal Pacing. J Am Coll Cardiol 2020; 75:347-359. [PMID: 32000945 DOI: 10.1016/j.jacc.2019.11.040] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is usually performed by biventricular (BiV) pacing. Previously, feasibility of transvenous implantation of a lead at the left ventricular (LV) endocardial side of the interventricular septum, referred to as LV septal (LVs) pacing, was demonstrated. OBJECTIVES The authors sought to compare the acute electrophysiological and hemodynamic effects of LVs with BiV and His bundle (HB) pacing in CRT patients. METHODS Temporary LVs pacing (transaortic approach) alone or in combination with right ventricular (RV) (LVs+RV), BiV, and HB pacing was performed in 27 patients undergoing CRT implantation. Electrophysiological changes were assessed using electrocardiography (QRS duration), vectorcardiography (QRS area), and multielectrode body surface mapping (standard deviation of activation times [SDAT]). Hemodynamic changes were assessed as the first derivative of LV pressure (LVdP/dtmax). RESULTS As compared with baseline, LVs pacing resulted in a larger reduction in QRS area (to 73 ± 22 μVs) and SDAT (to 26 ± 7 ms) than BiV (to 93 ± 26 μVs and 31 ± 7 ms; both p < 0.05) and LVs+RV pacing (to 108 ± 37 μVs; p < 0.05; and 29 ± 8 ms; p = 0.05). The increase in LVdP/dtmax was similar during LVs and BiV pacing (17 ± 10% vs. 17 ± 9%, respectively) and larger than during LVs+RV pacing (11 ± 9%; p < 0.05). There were no significant differences between basal, mid-, or apical LVs levels in LVdP/dtmax and SDAT. In a subgroup of 16 patients, changes in QRS area, SDAT, and LVdP/dtmax were comparable between LVs and HB pacing. CONCLUSIONS LVs pacing provides short-term hemodynamic improvement and electrical resynchronization that is at least as good as during BiV and possibly HB pacing. These results indicate that LVs pacing may serve as a valuable alternative for CRT.
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Affiliation(s)
- Floor C W M Salden
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - Sjoerd W Westra
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - Bob Weijs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Elien B Engels
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Luuk I B Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Léon J M Lamerichs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Michel H G Janssen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Kristof J H Clerx
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Richard Cornelussen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Medtronic PLC, Bakken Research Center, Maastricht, the Netherlands
| | - Subham Ghosh
- Medtronic PLC, Cardiac Rhythm and Heart Failure (CRHF), Mounds View, Minnesota
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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Salden FCWM, Kutyifa V, Stockburger M, Prinzen FW, Vernooy K. Atrioventricular dromotropathy: evidence for a distinctive entity in heart failure with prolonged PR interval? Europace 2019; 20:1067-1077. [PMID: 29186415 DOI: 10.1093/europace/eux207] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/25/2017] [Indexed: 01/07/2023] Open
Abstract
Heart failure (HF) is often accompanied by atrioventricular (AV) conduction disturbance, represented by prolongation of the PR interval on the electrocardiogram. Studies suggest that PR prolongation exists in at least 10% of HF patients, and it seems more prevalent in the presence of prolonged QRS duration. A prolonged PR interval may result in elevated left ventricular (LV) end-diastolic pressure, diastolic mitral regurgitation, and reduced LV pump function. This seems especially the case in patients with heart disease, in whom it is associated with an increased risk for atrial fibrillation, advanced AV heart block, HF, and death. These findings point towards the importance of proper AV coupling in HF patients. A few studies, strongly differing in design, suggest that restoration of AV coupling in patients with PR prolongation by pacing improves cardiac function and clinical outcomes. These observations argue for AV-dromotropathy as a potential target for pacing therapy, but other studies show inconsistent results. Given its potential clinical implications, restoration of AV coupling by pacing warrants further investigation. Additional possible future research goals include assessing different techniques to measure compromised AV coupling, determine the best site(s) of ventricular pacing, and assess a potential influence of diastolic mitral regurgitation in the efficacy of such therapy.
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Affiliation(s)
- Floor C W M Salden
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Valentina Kutyifa
- Heart Research Follow-Up Program, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY, USA
| | - Martin Stockburger
- Department of Cardiology, Havelland Kliniken, Ketziner Straße 21, Nauen, Germany.,Department of Cardiology and Angiology, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Frits W Prinzen
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, ER Maastricht, The Netherlands
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