Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy

Brecker, Stephen; Xiao, Han; Sparrow, Jane; Gibson, D G

doi:10.1016/0140-6736(92)92492-x

Cited by 333 publications

(120 citation statements)

References 29 publications

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“…Electrical dyssynchrony may not adequately describe the degree of mechanical dyssynchrony present; and therefore, the QRS duration may not be the best predictor of patient response to CRT [10][11][12]. Efforts have been made to improve the selection of patients who might benefit from CRT by using imaging modalities to define cardiac dyssynchrony more precisely.…”

Section: Introductionmentioning

confidence: 99%

Repeatability and reproducibility of phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging used to quantify cardiac dyssynchrony

Trimble¹,

Velázquez²,

Adams³

et al. 2008

Nuclear Medicine Communications

136

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Section: Introductionmentioning

confidence: 99%

Repeatability and reproducibility of phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging used to quantify cardiac dyssynchrony

Trimble¹,

Velázquez²,

Adams³

et al. 2008

Nuclear Medicine Communications

136

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“…5,6 Short atrioventricular delay pacing may also reduce presystolic mitral regurgitation. 7 In several acute hemodynamic and echocardiographic studies, however, LV pacing has been shown to produce greater or equal improvements in parameters than biventricular pacing 8 -11 despite increasing rather than decreasing QRS duration. 8 Furthermore, the acute hemodynamic benefit of LV pacing was predicted by higher pulmonary capillary wedge pressure but not by QRS duration.…”

mentioning

confidence: 99%

Left Ventricular Pacing Minimizes Diastolic Ventricular Interaction, Allowing Improved Preload-Dependent Systolic Performance

et al. 2004

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Background-Left ventricular (LV) pacing improves hemodynamics in patients with heart failure. We hypothesized that at least part of this benefit occurs by minimization of external constraint to LV filling from ventricular interaction. Methods and Results-We present median values (interquartile ranges) for 13 heart failure patients with LV pacing systems implanted for New York Heart Association class III/IV limitation. We used the conductance catheter method to measure LV pressure and volume simultaneously. External constraint was measured from the end-diastolic pressure-volume relation recorded during inferior vena caval occlusion, during LV pacing, and while pacing was suspended. External constraint to LV filling was reduced by 3.0 (4.6 to 0.6) mm Hg from 4.8 (0.6 to 7.5) mm Hg (PϽ0.01) in response to LV pacing; effective filling pressure (LV end-diastolic pressure minus external constraint) increased by 4.0 (2.2 to 5.8) mm Hg from 17.7 (13.3 to 22.6; PϽ0.01). LV end-diastolic volume increased by 10 (3 to 11) mL from 238 (169 to 295) mL (Pϭ0.01), whereas LV end-systolic volume did not change significantly (Ϫ1 [Ϫ2 to 3] mL from 180 [124 to 236] mL, Pϭ0.97), which resulted in an increase in stroke volume of 11 (5 to 13) mL from 49 (38 to 59) mL (PϽ0.01). LV stroke work increased by 720 (550 to 1180) mL ⅐ mm Hg from 3400 (2110 to 4480) mL ⅐ mm Hg (Pϭ0.01), and maximum dP/dt increased by 120 (2 to 161) mm Hg/s from 635 (521 to 767) mm Hg/s (Pϭ0.03). Conclusions-This study suggests a potentially important mechanism by which LV pacing may produce hemodynamic benefit. LV pacing minimizes external constraint to LV filling, resulting in an increase in effective filling pressure; the consequent increase in LV end-diastolic volume increases stroke volume via the Starling mechanism. (Circulation.

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“…Prolonged electrical activation resulting in a compromised sequence of activation is present within the atria (intra-atrial dyssynchrony), between atria and ventricles [atrioventricular (AV) dyssynchrony], within the LV (intraventricu- Activated [34] Reduced activation [34] Apoptotic cell death Activated [38] Reduced activation [37,38] ß-adrenergic signalling Reduced [43] Increased [43] Cellular-regional LV Decreased hypertrophy in late-activated regions [40] Metabolic Overall myocardial oxygen consumption Unchanged [46,48] Unchanged [46,48] Cardiac efficiency Decreased [46,48] Improved [46,48] Regional differences in myocardial blood flow Present [23] Ameliorated by CRT [40] Haemodynamic Diastolic filling time Shortened [32] Prolonged [45] Functional mitral regurgitation Increased [19] Decreased [44] Systolic pump function Decreased [32] Improved [43] Clinial events Hospitalization rates for heart failure (HF)…”

Section: Introductionmentioning

confidence: 99%

“…Mechanically, PR prolongation results in decreased time for atrial contribution to ventricular filling [18] and increased susceptibility to presystolic mitral regurgitation [19], and may thus compromise stroke volume because of impaired preload. By pacing with an appropriate timing interval between the right atrium and the ventricles, haemodynamic improvements are observed [20].…”

Section: Introductionmentioning

confidence: 99%

Cardiac resynchronization therapy: a breakthrough in heart failure management

Ståhlberg

Lund

Zabarovskaja

et al. 2012

Journal of Internal Medicine

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Abstract. Stå hlberg M, Lund LH, Zabarovskaja S, Gadler F, Braunschweig F, Linde C (Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden). Cardiac resynchronization therapy: a breakthrough in heart failure management (Review). J Intern Med 2012; 272: 330-343.Heart failure is now considered an epidemic. In patients with heart failure, electrical and mechanical dyssynchrony, evident primarily as prolongation of the QRS-complex on the surface electrocardiogram, is associated with detrimental effects on the cardiovascular system at several levels. In the past 10 years, studies have demonstrated that by stimulating both cardiac ventricles simultaneously, or almost simultaneously [cardiac resynchronization therapy (CRT)], the adverse effects of dyssynchrony can be overcome. Here, we provide a comprehensive overview of different aspects of CRT including the rationale behind and evidence for efficacy of the therapy. Issues with regard to gender effects and patient follow-up as well as a number of unresolved concerns will also be discussed.

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Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy

Cited by 333 publications

References 29 publications

Repeatability and reproducibility of phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging used to quantify cardiac dyssynchrony

Repeatability and reproducibility of phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging used to quantify cardiac dyssynchrony

Left Ventricular Pacing Minimizes Diastolic Ventricular Interaction, Allowing Improved Preload-Dependent Systolic Performance

Cardiac resynchronization therapy: a breakthrough in heart failure management

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