Effect of triangle ventricular pacing on haemodynamics and dyssynchrony in patients with advanced heart failure: a comparison study with conventional bi-ventricular pacing therapy

Yoshida, Kentaro; Seo, Yoshihiro; Yamasaki, Hiro; Tanoue, Kazuyuki; Murakoshi, Nobuyuki; Ishizu, Tomoko; Sekiguchi, Yukio; Kawano, Satoru; Otsuka, Sadanori; Watanabe, Shigeyuki; Yamaguchi, Iwao; Aonuma, Kazutaka

doi:10.1093/eurheartj/ehm441

Cited by 50 publications

(26 citation statements)

References 22 publications

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“…For instance, in the BiV + intrinsic programming, the ventricles can be activated from 3 sites: 2 ventricular pacing sites localized in the left and right ventricles and the AVN (the sinus activation through AVN). Leclercq, et al 19) and Yoshida, et al 20) have reported that multi-site pacing demonstrates superior reverse remodeling of the left ventricle, together with increased LV dp/dt and cardiac output. Consistent with our findings in the present study, Vatasescu, et al showed a shorter LV activation time and a better CRT responder rate during bi-ventricular pacing with fusion, when compared to the results with conventional CRT.…”

Section: Discussionmentioning

confidence: 99%

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Guo

Zhang

et al. 2015

Int. Heart J.

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SummaryWe sought to evaluate the impact of biventricular (BiV) pacing with ventricular fusion by intrinsic atrioventricular nodal (AVN) conduction (BiV + intrinsic pacing) on clinical outcomes in patients with chronic heart failure (CHF) receiving cardiac resynchronization therapy (CRT).A total of 44 patients were randomized to receive either BiV or BiV + intrinsic pacing for one month. Echocardiographic optimization was performed for the BiV pacing mode, while the BiV + intrinsic pacing mode was achieved by titrating AV delay under electrocardiography (ECG) monitoring. Symptoms, quality of life, ECG, echocardiography, and cardiovascular events were recorded at baseline and the end of the follow-up for each pacing mode.Patients undergoing BiV + intrinsic pacing mode had shorter QRS duration compared to those with conventional BiV pacing (118.4 ± 21.6 ms versus 146.4 ± 5.3 ms, P < 0.0001). Also, these patients had improved echocardiographic left ventricular fractional shortening (LVFS) (17.4 ± 5.9 versus 15.7 ± 4.9, P = 0.019), higher left ventricular ejection fraction (LVEF) (35.5 ± 9.7 versus 32.7 ± 9.7, P = 0.048), longer 6-minute walk test (6MWT) (372.5 ± 80.9 m versus 328.7 ± 108.9 m, P = 0.0001), and better Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (12.5 ± 6.6 versus 18.2 ± 12.3, P = 0.0001).Treating CHF patients with BiV+intrinsic pacing resulted in improved cardiac function and quality of life. BiV + intrinsic pacing can be used in CHF patients with sinus rhythm and normal AV nodal conduction to improve CRT efficacy. (Int Heart J 2015; 56: 293-297) Key words: Intrinsic conduction, Heart failure, Electrocardiography, Echocardiography C ongestive heart failure (CHF) is a major public health problem associated with high mortality and morbidity. 1) Common causes of CHF include, but are not limited to ischemic heart disease, hypertension, arrhythmias, valvular diseases, cardiomyopathies, and congenital heart diseases.2,3) Cardiac resynchronization therapy (CRT), also known as biventricular pacing (BiV) or multisite ventricular pacing, simultaneously paces the right ventricle and the left ventricle. Large randomized clinical trials have shown that CRT improves symptoms, cardiac functions, and survival in patients with heart failure who have electrical dyssynchrony. CRT has been recommended by the American Heart Association (AHA) guidelines for patients with recurrent symptoms of systolic heart failure and a wide QRS complex, despite being on optimal medical therapy. [4][5][6][7][8] CRT allows for more efficient blood ejection by reducing mechanical inefficiency from dyssynchronous contraction. 3,9,10) However, there is a wide spectrum of clinical responses to CRT and one third of the patients who are selected for CRT fail to demonstrate any benefit from it.11,12) Therefore, the current clinical focus in CRT is to maximize the benefit from this therapy.A physiological approach to pacing is important for patients with CHF. It can be achieved by a number of methods including CRT, rate ada...

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Section: Discussionmentioning

confidence: 99%

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Guo

Zhang

et al. 2015

Int. Heart J.

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“…Recent data show that dual site RV pacing associated with LV pacing produced superior LV resynchronization and systolic performance when compared with conventional Biv pacing 30 and that reverse remodelling with dual site LV pacing associated with RV pacing is superior to conventional Biv pacing. 31 These data strengthen the idea of the superiority of three activation fronts during CRT (a situation reproduced during CRT with fusion).…”

Section: Discussionmentioning

confidence: 99%

Midterm 'super-response' to cardiac resynchronization therapy by biventricular pacing with fusion: insights from electro-anatomical mapping

et al. 2009

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AimsSome authors recommend avoiding fusion with left ventricular (LV) intrinsic depolarization during cardiac resynchronization therapy (CRT). If fusion is still present during optimized biventricular (Biv) pacing and its long-term effects on the response to CRT are currently unknown. The aim of the study was to analyse the endocardial LV activation pattern induced by echocardiographically optimized Biv pacing and its influence on LV reverse remodelling.Methods and resultsContact electro-anatomical mapping was performed in 15 heart failure (HF) patients with left bundle branch block and echocardiographically optimized CRT (seven ischaemic aetiology, 64 ± 8 years, three women, New York Heart Association class 3 ± 0.4, LV ejection fraction 25 ± 5%). Left ventricular activation maps were performed in sinus rhythm (SR), during DDD right ventricular apical (RVA) and optimized Biv pacing. Fusion with intrinsic rhythm during pacing was considered when LV septal activation was produced at least partially by intrinsic depolarization, when compared with LV activation map during SR. Patients were considered responders to CRT if they had ≥10% reduction in LV end-systolic volume (LVESV) after 6 months of CRT. During SR, the LV breakthrough was mid-septal (n = 12), basal septum (n = 2), and apical (n = 1). During RVA pacing, LV breakthrough shifted apical in all patients. Right ventricular apical/Biv pacing proved fusion with intrinsic depolarization in 8 of 15 patients. The PR interval was shorter in patients with fusion RVA/Biv pacing (164 ± 24 vs. 234 ± 55 ms, P = 0.006). There was a trend for shorter LV activation time (LVat) in patients with fusion during RVA pacing (87 ± 33 vs. 113 ± 21 ms, P = 0.08) as well as during optimized Biv pacing (83 ± 18 vs. 104 ± 24 ms, P = 0.07), although LVat was similar in SR (100 ± 22 vs. 106 ± 20, P = NS). In patients with fusion, 6 months responder rate was significantly higher (100 vs. 28.5%, P < 0.007) as was the degree of LVESV reduction (39 ± 17 vs. 1.0 ± 14%, P < 0.001).ConclusionBiventricular pacing with fusion may substantially increase the structural responder rate probably by shortening LVat.

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“…Let-7i, miR-132, miR-199a) of many host cellular miRNAs [67]. The modulation of these host miRNAs has an effect on the expression of cellular proteins such as p300, NF-kB, and BRM, to name a few, which are all recruited by Tax and play a key role in activating HTLV-1 gene transcription [5,[30][31][32][33][34][35][36][38][39][40][44][45]56,60,[68][69][70][71]. To better define the functional significance of Drosha downregulation by Tax, we transfected 293T cells with pACH.Tax (5 mg) and 24 hours later added back pGFP-Drosha (10 mg).…”

Section: Suppression Of Cellular Mirnas By Htlv-1 Can Be Rescued By Omentioning

confidence: 99%

Localization and Sub-Cellular Shuttling of HTLV-1 Tax with the miRNA Machinery

et al. 2012

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The innate ability of the human cell to silence endogenous retroviruses through RNA sequences encoding microRNAs, suggests that the cellular RNAi machinery is a major means by which the host mounts a defense response against present day retroviruses. Indeed, cellular miRNAs target and hybridize to specific sequences of both HTLV-1 and HIV-1 viral transcripts. However, much like the variety of host immune responses to retroviral infection, the virus itself contains mechanisms that assist in the evasion of viral inhibition through control of the cellular RNAi pathway. Retroviruses can hijack both the enzymatic and catalytic components of the RNAi pathway, in some cases to produce novel viral miRNAs that can either assist in active viral infection or promote a latent state. Here, we show that HTLV-1 Tax contributes to the dysregulation of the RNAi pathway by altering the expression of key components of this pathway. A survey of uninfected and HTLV-1 infected cells revealed that Drosha protein is present at lower levels in all HTLV-1 infected cell lines and in infected primary cells, while other components such as DGCR8 were not dramatically altered. We show colocalization of Tax and Drosha in the nucleus in vitro as well as coimmunoprecipitation in the presence of proteasome inhibitors, indicating that Tax interacts with Drosha and may target it to specific areas of the cell, namely, the proteasome. In the presence of Tax we observed a prevention of primary miRNA cleavage by Drosha. Finally, the changes in cellular miRNA expression in HTLV-1 infected cells can be mimicked by the add back of Drosha or the addition of antagomiRs against the cellular miRNAs which are downregulated by the virus.

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Effect of triangle ventricular pacing on haemodynamics and dyssynchrony in patients with advanced heart failure: a comparison study with conventional bi-ventricular pacing therapy

Abstract: The acute beneficial effects of Tri-V on LV function and dyssynchrony were greater than those of Bi-V.

Cited by 50 publications

References 22 publications

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Midterm 'super-response' to cardiac resynchronization therapy by biventricular pacing with fusion: insights from electro-anatomical mapping

Localization and Sub-Cellular Shuttling of HTLV-1 Tax with the miRNA Machinery

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