Bifocal Right Ventricular Resynchronization for the Failing Right Ventricle

Berruezo, Antonio; Potter, Tom De; Sitges, Marta; Mansour, Fadi; Mont, Lluı́s; Brugada, Josep

doi:10.1111/j.1540-8159.2010.02794.x

Cited by 2 publications

(4 citation statements)

References 7 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pacing the latest activated site (usually the RV free wall in PAH 72,73 ) has demonstrated acute hemodynamic improvement 74 as well as clinical and echocardiographic improvement in a case study. 75…”

Section: Future Directionsmentioning

confidence: 99%

Lung Transplantation for Pulmonary Hypertension and Strategies to Bridge to Transplant

Baillie

Granton

2017

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Despite an expanded armamentarium of medical therapies, pulmonary arterial hypertension (PAH) remains a progressive disease associated with significant morbidity and premature mortality. Lung transplantation (LT) is the last safety net for patients failing medical therapy, providing excellent overall long-term survival and health-related quality-of-life outcomes in line with more common parenchymal lung disease indications. Waitlist mortality remains disproportionally elevated, however, reflecting an inability of the lung allocation score to completely capture PAH disease severity, and a propensity for PAH to deteriorate rapidly without warning, even in patients who appear externally “well.” Early referral to a LT center can mitigate these risks and facilitate rapid listing if necessary. Several bridging therapies are available to support severely unwell patients to LT, such as extracorporeal life support (ECLS) and atrial septostomy. Unique perioperative considerations include higher rates of primary graft dysfunction and dynamic right ventricular outflow obstruction which may, at least in part, reflect rapid afterload reduction in the face of a conditioned right ventricle. Extending ECLS into the perioperative period may ameliorate these risks by allowing more gradual adaptation of both ventricles to their new loading conditions. Chronic lung allograft dysfunction, particularly bronchiolitis obliterans syndrome, remains a major cause of long-term morbidity and mortality, and complications from corticosteroid and immunosuppressive therapy are common. Nevertheless, the morbidity, mortality, and burden of disease management after LT continue to improve and compare favorably to that of refractory PAH in carefully selected patients.

show abstract

Section: Future Directionsmentioning

confidence: 99%

Lung Transplantation for Pulmonary Hypertension and Strategies to Bridge to Transplant

Baillie

Granton

2017

Semin Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…RV pacing has been shown to be beneficial in patients with RV dysfunction and RBBB in the setting of tetralogy of Fallot and aortic stenosis status after Ross procedure. 53 In 2010, Berruezo et al 54 published a case report of a patient with WHO group III pulmonary hypertension, RV failure, and RBBB who developed complete atrioventricular block requiring pacemaker implantation. Because of the presence of RV dysfunction, dP/dt was measured while pacing various sites before placing leads in the RA appendage and His bundle region.…”

Section: Cardiac Resynchronization For Left Ventricular Failurementioning

confidence: 99%

Section: Cardiac Resynchronization For the Failing Right Ventriclementioning

confidence: 99%

“…At 3 months of follow-up, the patient had markedly improved clinical status from New York Heart Association class IV to II, ability to walk more than 450 m on 6-minute walk test, and slight improvement in global RV function by echocardiography. 54 Experience with left ventricular CRT has suggested that pacing in the latest activated site optimizes the chance of inducing ventricular function improvements. 55,56 It is in-teresting to note that all of the studies that look at mechanical activation in the context of pulmonary hypertension find the RV free wall to consistently be the latest site of mechanical activation.…”

Section: Cardiac Resynchronization For the Failing Right Ventriclementioning

confidence: 99%

See 1 more Smart Citation

Is Cardiac Resynchronization Therapy for Right Ventricular Failure in Pulmonary Arterial Hypertension of Benefit?

et al. 2014

View full text Add to dashboard Cite

Pulmonary arterial hypertension is a manifestation of a group of disorders leading to pulmonary vascular remodeling and increased pulmonary pressures. The right ventricular (RV) response to chronic pressure overload consists of myocardial remodeling, which is in many ways similar to that seen in left ventricular (LV) failure. Maladaptive myocardial remodeling often leads to intraventricular and interventricular dyssychrony, an observation that has led to cardiac resynchronization therapy (CRT) for LV failure. CRT has proven to be an effective treatment strategy in subsets of patients with LV failure resulting in improvement in LV function, heart failure symptoms, and survival. Current therapy for pulmonary arterial hypertension is based on decreasing pulmonary vascular resistance, and there is currently no effective therapy targeting the right ventricle or maladaptive ventricular remodeling in these patients. This review focuses on the RV response to chronic pressure overload, its effect on electromechanical coupling and synchrony, and how lessons learned from left ventricular cardiac resynchronization might be applied as therapy for RV dysfunction in the context of pulmonary arterial hypertension.Keywords: pulmonary hypertension, pulmonary arterial hypertension, right ventricular failure, dyssynchrony, cardiac resynchronization therapy. Pulmonary arterial hypertension is a manifestation of a group of disorders that cause pulmonary vascular remodeling, alterations in pulmonary vascular resistance, and reduced compliance. Ultimately, increased pulmonary pressures may induce alterations in right ventricular structure and function. Current therapy is largely based on targeting biochemical pathways to decrease pulmonary vascular resistance. Despite this, the final common pathway for many patients remains right ventricular failure and death. Although left ventricular (LV) failure has been well characterized, leading to multiple therapies with proven mortality benefit, less is known about the failing right ventricle (RV). In fact, early evaluation of the role of RV function in disease states (i.e., RV free wall infarction/ ablation, Fontan physiology, or lung transplantation) suggested that the RV was highly adaptable and perhaps superfluous to overall cardiac function in the absence of sustained pulmonary arterial hypertension. However, recent improvements in imaging and technology, including strain imaging, tissue Doppler imaging (TDI), and magnetic resonance imaging (MRI) have led to a better understanding of the adaptation of the RV to chronic pressure overload.Many similarities between RV and LV failure have been observed, including changes in mechanical function, RV global and myocyte structure and function, 2 myocardial blood flow, 3 and electrophysiologic properties. 4 In a limited number of mechanical interventions in the pulmonary circulation (lung transplantation and pulmonary artery endarterectomy), RV reverse remodeling has been noted, suggesting a reversible component to RV remodeling related t...

show abstract

Bifocal Right Ventricular Resynchronization for the Failing Right Ventricle

Cited by 2 publications

References 7 publications

Lung Transplantation for Pulmonary Hypertension and Strategies to Bridge to Transplant

Lung Transplantation for Pulmonary Hypertension and Strategies to Bridge to Transplant

Is Cardiac Resynchronization Therapy for Right Ventricular Failure in Pulmonary Arterial Hypertension of Benefit?

Contact Info

Product

Resources

About