Cardiac resynchronization therapy: A novel adjunct to the treatment and prevention of systemic right ventricular failure

Abstract

The CRT yielded improvement in systemic RV function in patients with spontaneous or LV pacing-induced electromechanical dyssynchrony and seems to be a promising adjunct to the treatment and prevention of systemic RV failure.

Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance

“…Some studies have shown that biventricular (BiV) pacing appears to preserve systemic ventricular function in ccTGA patients. Janousek et al initially reported the benefits of cardiac resynchronization therapy (CRT) in a small case series of 8 patients with systemic RV including ccTGA, in whom there was significant improvement in the RV fractional area change (RVFAC) as well as NYHA functional class 33. Recently, Hofferberth et al reported their evolving experience with 53 patients with ccTGA who received primary dual‐chamber UniV pacemakers.…”

“…However, the presence of large Thebesian veins and extensive collateralization between the RV and LV at both anterior and posterior interventricular grooves via the anterior intraventricular vein and middle cardiac vein offer alternative routes for pacing of the morphologic RV anteriorly or posteriorly 37. Alternatively, biV pacing may be performed by surgical placement of epicardial LV and RV pacing leads or with a hybrid approach that involves surgical placement of an epicardial RV pacing lead and transvenous placement of an endocardial LV lead 33, 38…”

Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure

“…[31][32][33] Although it is not definitively clear whether it is better to pace the RV or the LV first, it is evident that nonsimultaneous pacing improves cardiac hemodynamics in the face of RV dysfunction. [31][32][33] Clinical benefits were demonstrated for patients with right heart dysfunction [34][35][36] with or without a pre-existing right bundle branch block. 34,35 For those with a right bundle branch block, pacing the RV first narrowed the QRS and improved RV dP/dt and systemic hemodynamics.…”

“…[31][32][33] Clinical benefits were demonstrated for patients with right heart dysfunction [34][35][36] with or without a pre-existing right bundle branch block. 34,35 For those with a right bundle branch block, pacing the RV first narrowed the QRS and improved RV dP/dt and systemic hemodynamics. 34,35 Importantly, the benefit of the IVS is due not only to movement but also to contractility and the overall systolic performance of the LV, which, when increased, can produce a more vigorous movement of the IVS toward the right.…”

“…34,35 For those with a right bundle branch block, pacing the RV first narrowed the QRS and improved RV dP/dt and systemic hemodynamics. 34,35 Importantly, the benefit of the IVS is due not only to movement but also to contractility and the overall systolic performance of the LV, which, when increased, can produce a more vigorous movement of the IVS toward the right. Inactivation or akinesis of the IVS in models of RV dysfunction results in a 30-40% reduction in RV performance (RV dP/dt).…”