Detrimental Ventricular Remodeling in Patients With Congenital Complete Heart Block and Chronic Right Ventricular Apical Pacing

Thambo, Jean-Benoît; Bordachar, Pierre; Garrigue, Stéphane; Lafitte, Stéphane; Sanders, Prashanthan; Reuter, Sylvain; Girardot, Romain; Crépin, D; Réant, Patricia; Roudaut, R.; Jaı̈s, Pierre; Haı̈ssaguerre, Michel; Clémenty, Jacques; Jimenez, Maria

doi:10.1161/01.cir.0000150336.86033.8d

Cited by 438 publications

(308 citation statements)

References 34 publications

(20 reference statements)

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“…Since the 1980s, evidence of the harmful effects of RV apical pacing related to the long-term effects on cardiac structure and function has been reported [23][24][25][26] . High levels of stimulation in the ventricular channel may lead to undesirable left ventricular remodeling, with consequent increased morbidity and mortality, particularly in patients presenting systolic dysfunction 27 .…”

Section: Methodsmentioning

confidence: 99%

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

Júnior

Maeda

Borges

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction: The septal position is an alternative site for cardiac pacing (CP) that is potentially less harmful to cardiac function. Methods: Patients with Chagas disease without heart failure submitted to permanent pacemaker (PP) implantation at the Clinics Hospital of the Triângulo Mineiro Federal University (UFTM), were selected from February 2009 to February 2010. The parameters analyzed were ventricular remodeling, the degree of electromechanical dyssynchrony (DEM), exercise time and VO2 max during exercise testing (ET) and functional class (NYHA). Echocardiography was performed 24 to 48h following implantation and after one year follow-up. The patients were submitted to ET one month postprocedure and at the end of one year. Results: Thirty patients were included. Patient mean age was 59±13 yearsold. Indication for PP implantation was complete atrioventricular (AV) block in 22 (73.3%) patients and 2 nd degree AV block in the other eight (26.7%). All patients were in NYHA I and no changes occurred in the ET parameters. No variations were detected in echocardiographic remodeling measurements. Intraventricular dyssynchrony was observed in 46.6% of cases and interventricular dyssynchrony in 33.3% of patients after one year. Conclusions: The findings of this work suggest that there is not significant morphological and functional cardiac change following pacemaker implantation in septal position in chagasic patients with normal left ventricular function after one year follow-up. Thus, patients may remain asymptomatic, presenting maintenance of functional capacity and no left ventricular remodeling.

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Section: Methodsmentioning

confidence: 99%

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

Júnior

Maeda

Borges

et al. 2012

Rev. Soc. Bras. Med. Trop.

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“…Nevertheless, RV apical pacing continues to be practiced by many physicians because of its easy accessibility and relative stability over time (1,2). The optimal mode and site of pacing remain undefi ned.…”

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confidence: 99%

TUGENDHAT: a pilot randomized study on effects of biventricular pacing in patients with bradycardia pacing indication and normal systolic function on heart failure, atrial fibrillation and quality of life (results of 12 month follow-up)

Táborský

Ríhová²,

Mráz³

et al. 2013

BLL

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Abstract:Background: Since the late 1990s, a growing number of clinical studies have indicated that long-term permanent right ventricular (RV) apical pacing will induce severe complications such as development of heart failure, increased burden of atrial fi brillation leading to decreased quality of life. Aim of the study: To investigate whether cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing can prevent the development of left ventricular (LV) dysfunction, LV remodelling, worsening of the clinical status and quality of life in chronically RV paced patients with normal LV ejection fraction (EF). Methods and results:A total of 127 patients with Class I indication for permanent cardiac pacing and without established indication for CRT were subjected to 6 months of RV and BiV pacing in a patient-blinded, randomized crossover trial. Treatment effects of BiV pacing were evaluated for LV function, LV remodelling and clinical status. Conclusion: BiV pacing, compared to RV pacing, did not change LV function and quality of life in patients with the absence of LV dysfunction or remodelling, standard bradycardia pacing indications in a pilot phase (12-month follow-up) of the TUGENDHAT trial. The fi nal report will be published after 60-month follow-up termination (Tab. 5, Fig. 3, Ref. 30). Full Text in PDF www.elis.sk. Key words: BiV and RV pacing, LV remodelling, heart failure, atrial fi brillation, quality of life. Results of several trials have supported the fact that right ventricular (RV) apical pacing might lead to adverse clinical outcomes in patients with standard pacing indications. Nevertheless, RV apical pacing continues to be practiced by many physicians because of its easy accessibility and relative stability over time (1, 2). The optimal mode and site of pacing remain undefi ned.The detrimental effect of RV pacing is probably most important in patients with pre-existing left ventricular (LV) dysfunction and may lead to worsening of heart failure (3, 4). In RV pacing, the sequence of electrical activation resembles the activation pattern in left bundle branch block (LBBB). This asynchronous electrical pattern is accompanied by abnormal dyssynchronous mechanical interactions within the LV (5). Experimental data suggested that biventricular (BiV) pacing might preserve myocardial performance better than RV apical pacing in patients with atrioventricular (AV) block and normal systolic function (6). The underlying mechanism may be a signifi cant reduction in LV systolic dyssynchrony, as shown by Cojoc et al (7). In the majority of patients with severe LV dysfunction and severe clinical heart failure associated with either LBBB-or RV pacing-induced dyssynchrony, BiV pacing improves clinical status, reduces mortality and morbidity, reduces heart failure (HF) hospitalizations, reverses LV remodelling and improves LV function (8, 9). Therefore, BiV pacing is nowadays recommended in patients with ventricular dyssynchrony (QRS > 120 ms), severe LV dysfunction [LV ejection fraction (LVEF) < 0.35] ...

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“…Outras causas, todavia, também têm sido citadas como responsáveis pelo desenvolvimento de miocardiopatia dilatada nestes pacientes, em especial a miocardite viral e os efeitos deletérios da estimulação artificial crônica do ventrículo direito (VD) 29,[31][32][33][34] .…”

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“…Estudos que avaliaram comparativamente a evolução de crianças com estimulação crônica do VD em relação a grupo controle constituído por indivíduos sem marca-passo identificaram o desenvolvimento de remodelamento e de disfunção ventricular, presença de dissincronia intraventricular esquerda, menor capacidade ao exercício físico, níveis elevados de peptídeo natriurético tipo B (BNP) e aumento da duração do complexo QRS, sendo que a estimulação apical do VD e o aumento da duração do complexo QRS foram fatores preditores da redução da função sistólica do ventrículo esquerdo 33,38,39 . A reversão do processo de remodelamento ventricular pela terapia de ressincronização cardíaca, que é obtida pela mudança do tipo de marca-passo de VD para biventricular, tem sido relatada em vários estudos [40][41][42][43][44][45][46][47][48][49] .…”

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“…Este fenômeno tem sido reportado, maiormente, na população adulta com distúrbios adquiridos da condução elétrica cardíaca 34,37 . A despeito do pequeno número de estudos encontrados na literatura, a dissincronia e o remodelamento ventricular também foram reportados em crianças com bloqueio AV congênito 27,29,33 . No ; e) a duração do complexo QRS quando o coração é estimulado pelo marca-passo 27,42,46 ; f) a presença de dissincronia ao ecocardiograma 41,118 e, g) a presença de autoanticorpos maternos 4,71,78 .…”

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Avaliação da estimulação ventricular direita crônica em crianças e adultos jovens com bloqueio atrioventricular congênito isolado

Junior¹,

de²

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Avaliação da estimulação ventricular direita crônica em crianças e adultos jovens com bloqueio atrioventricular congênito isoladoincentivo profissional e intelectual dentro e fora do marca-passo. À Dra. Elizabeth Sartori Crevelari, pelo apoio e amizade dentro e fora do centro cirúrgico.Aos amigos e irmãos, os Doutores Luiz Tenório, Orly Larceda, JoséRenato e Aldryn Nunes, por terem me incentivado a entrar na Pós-graduação e, sobretudo, pela amizade espontânea que nos anima até hoje cada qual a seu modo e apesar das distâncias.Ao Amigo Dr. Caio Marcos de Moraes Albertini, pelo companheirismo e incentivo pessoal e profissional. À Dra. Sávia Cristina Bueno, ex-companheira de Pós-Graduação, pelo convívio e ajuda na execução dos créditos. Sem você teria sido mais difícil. À Enfermeira Marianna Sobral Lacerda, pela amizade, apoio e diligência na coleta dos dados deste trabalho.Aos Pesquisadores Tatiana Kawauchi e Lucas Bassolli, pela contribuição na finalização desta tese, seja na elaboração do artigo, seja na análise estatística, respectivamente.

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Detrimental Ventricular Remodeling in Patients With Congenital Complete Heart Block and Chronic Right Ventricular Apical Pacing

Cited by 438 publications

References 34 publications

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

TUGENDHAT: a pilot randomized study on effects of biventricular pacing in patients with bradycardia pacing indication and normal systolic function on heart failure, atrial fibrillation and quality of life (results of 12 month follow-up)

Avaliação da estimulação ventricular direita crônica em crianças e adultos jovens com bloqueio atrioventricular congênito isolado

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