Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction

Abstract

In patients with normal systolic function, conventional right ventricular apical pacing resulted in adverse left ventricular remodeling and in a reduction in the left ventricular ejection fraction; these effects were prevented by biventricular pacing. (Centre for Clinical Trials number, CUHK_CCT00037.)

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

“…Pequeños estudios aleatorizados han señalado que los pacientes con disfunción del VI moderada-grave podrían beneficiarse de la TRC en lugar de la estimulación apical del VD convencional (tabla 15) [123][124][125][126][127][128][129][130] . En general, los objetivos primarios de estos estudios se sustituyeron por objetivos hemodinámicos.…”

Permanent Cardiac Pacing in Adults with High Grade Atriovetricular Block and Preserved Left Ventricular Function: Optimal Mode and Site of Pacing

“…Initially, attention was directed to RV outflow tract/septum pacing and His/para-Hisian pacing in patients with LV dysfunction ( Mera et al, 1999;Schwaab et al, 1999;Buckingham et al, 1997;Buckingham et al, 1998;de Cock et al, 1998) and latter in preserved LV function patients (Giudici et al, 1997;Karpawich & Mital, 1997;Kolettis et al, 2000;Bourke et al, 2002;Tse et al, 2002;Occhetta et al, 2006;Victor et al, 2006;Yu et al, 2007;Kypta et al, 2008;Flevari et al, 2009;Ng et al, 2009;Dabrowska-Kugacka et al, 2009;Takemoto et al, 2009;Gong et al, 2009;Rosso et al, 2010;Verma et al , 2010;106:806-9;Leong et al, 2010;Cano et al,. 2010;Yoshikawa et al, 2010) while subsequently biventricular stimulation began to emerge as an appealing alternative proposal (Yu et al, 2009;Simantirakis et al, 2009;Doshi et al, 2005). Despite attempts to corroborate the theoretical superiority of alternative RV pacing sites, such as septal and His/para-Hisian pacing, the reported outcomes remain conflicting and their efficacy equivocal.…”

“…Results from acute and chronic studies are summarized in table 1 and show mixed results with a tendency toward better hemodynamic outcome when pacing at these alternative sites (Giudici et al, 1997;Kolettis et al, 2000;Tse et al, 2002;Yu et al, 2007;Flevari et al, 2009;Takemoto et al, 2009;Yoshikawa et al, 2010;Yu et al, 2009;de Cock et al, 2003). AF: atrial fibrillation; AV : atrioventricular; AVNA: AV node ablation; AVB: atrioventricular block; DDD: dual chamber pacing; HRA: high right atrium ; NA: not available; PSP: Peak systolic pressure; RVS: right ventricle septum; RVOT: right ventricle outflow tract; RVA: right ventricle apex; SSS: sick sinus syndrome; VA: ventricular asynchrony; VRR : ventricular rate regularization; VVI: single chamber ventricular pacing; * the study population included only children; § LVEF ≤45% in 12 patients; ¥ LVEF <40% in 14% of patients; ¤ LVEF<40% in 1 patient.…”

“…The similarity of chronic outcome between pacing in the outflow and the lower septum implies that these sites may be equally useful as more physiological RV pacing sites than the RVA, especially when RV pacing cannot be avoided (Flevari et al, 2009;Rosso et al, 2010). The PACE study (Yu et al, 2009) showed that the mean left ventricular ejection fraction declined by almost 7 percentage points (from 61.5 ± 6.6 % to 54.8 ± 9.1 %) in the first year of RVA pacing in patients with a normal ejection fraction. Among nine patients in whom the LVEF decreased to less than 45% at 12 months, eight (89%) were in the right ventricularwww.intechopen.com pacing group.…”

“…Among nine patients in whom the LVEF decreased to less than 45% at 12 months, eight (89%) were in the right ventricularwww.intechopen.com pacing group. The authors suggests that the ejection fraction could decrease rapidly in vulnerable patients and that these patients might benefit even more from biventricular pacing (Yu et al, 2009). Nevertheless, the routine use of LV-based pacing for bradycardia in most patients without heart failure and preserved LVEF is impractical because of the longer procedure time, shorter battery life, higher cost and complications rates, such as lead dislodgement, and less reliability for long-term pacing.…”