Midterm Benefits of Left Univentricular Pacing in Patients With Congestive Heart Failure

Blanc, Jean‐Jacques; Bertault-Valls, Valérie; Fatemi, Mostafa; Gilard, Martine; Pennec, Pierre-Yves; Étienne, Yves

doi:10.1161/01.cir.0000124479.89015.64

Cited by 96 publications

(66 citation statements)

References 36 publications

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“…Experience with chronic biventricular pacing in children is sparse, but a multicenter study showed promising results with regard to cardiac function after 4 months of resynchronization therapy [11], and biventricular pacing proved effective in the treatment of six children with RV pacing-induced heart failure [20]. In adults with congestive heart failure, chronic LV lateral wall pacing (single-site, short AV delay) can be as effective as biventricular pacing [4,12,33]. To our knowledge, the effect of chronic biventricular pacing in children has not been compared with LV lateral wall pacing alone.…”

Section: Relation Between Pacing Site and LV Functionmentioning

confidence: 99%

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

et al. 2008

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Chronic right ventricular (RV) pacing can induce structural and functional cardiac deterioration. Because animal studies showed a benefit of left ventricular (LV) over RV pacing, this study compared the effects of chronic RV and LV pacing in children. Retrospectively, echocardiographic data were evaluated from 18 healthy children (control subjects) and from children undergoing chronic epicardial RV pacing (7 RVP) or LV pacing (7 LVP). Assessment included LV end-diastolic wall thickness (LVEDWT) and end-systolic wall thickness (LVESWT) as well as LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD). The shortening fraction and eccentricity index (LV diameter/2 9 LV wall thickness) were calculated as measures of LV function and eccentricity, respectively. Duration of QRS and septal posterior wall motion delay (SPWMD) were used as measures of electrical and mechanical dyssynchrony, respectively. A p value less than 0.05 determined significance. As the findings showed, LVEDD, LVESD, LVEDWT, and LVESWT were not significantly different between the groups. The shortening fraction was significantly lower in the RVP (21.7% ± 6.0%) than in the LVP (32.2% ± 5.2%) or control (29.3% ± 4.3%) children. The systolic LV eccentricity index was significantly larger in the RVP (1.8 ± 0.2) than in the LVP (1.4 ± 0.1) or control (1.4 ± 0.2) children. The SPWMD was significantly larger in the RVP (338 ± 20 ms) than in the LVP (-16 ± 14 ms) or control (-5 ± 35 ms) group, whereas QRS duration was similarly longer in the RVP (157 ± 10 ms) and LVP (158 ± 22 ms) groups compared than in the control group (69 ± 7 ms). The authors conclude that LV function in children is preserved by chronic pacing at the LV lateral wall.Keywords Cardiac function Á Children Á Dyssynchrony Á Pacing Á Site Á Ventricular In children and adults with congenital or acquired atrioventricular (AV) block, the ventricular pacing lead is traditionally positioned at the right ventricle (RV) [16,19]. However, RV apex pacing causes an acute decrease in left ventricular (LV) function in animals [26], adults [6] and children [14,36]. During chronic RV pacing in children, LV function, morphology [30,31], and histology [15] are at risk for deterioration over time (for review see Karpawich [16]). Chronic RV pacing can eventually result in cardiac failure, which occurs in 6% to 7% of children [17,20,38]. Also, in adults, chronic RV apex pacing has deleterious effects (for review see Manolis [19]) and increases the risk of heart failure [1,28].Recognition of the possible harmful effects from RV apex pacing initiated the search for alternative ventricular pacing sites including the RV outflow tract, His bundle, LV wall, and biventricular pacing. Pacing at the His bundle is likely the superior approach [8], but appears to be

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Section: Relation Between Pacing Site and LV Functionmentioning

confidence: 99%

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

et al. 2008

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“…24 Other factors will continue to warrant RV lead placement in many patients. Although no LV lead dislodgements were observed in the study by Blanc et al, 23 the incidence has been reported at 5% to 10% in larger studies. 11,25 Patients with poor LV function are at risk for sudden cardiac death from ventricular arrhythmias.…”

mentioning

confidence: 79%

“…3,19 -21 Two small studies suggested that benefit of single site LV pacing is persistent at 4 weeks and 6 months. 17,22 In this issue of Circulation, Blanc and coworkers 23 extend the follow-up observations of single site LV pacing. Functional capacity (6-minute walk and maximal O 2 uptake), ventricular size and function, and blood norepinephrine levels before and after 12 months of left univentricular pacing were evaluated in 22 patients with dilated cardiomyopathy, LBBB, and New York Heart Association class III or IV heart failure.…”

mentioning

confidence: 88%

Single Site Left Ventricular Pacing for Cardiac Resynchronization

Stevenson

Sweeney

2004

Circulation

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C hronic, dilated heart failure is often accompanied by delayed ventricular electrical activation manifested as prolonged QRS duration, most commonly in the form of left bundle branch block (LBBB). Exploration of the link between the sequence of cardiac electrical activation and mechanical function is one of the most exciting contemporary areas of research in heart failure, but recognition of the importance of normal ventricular activation patterns for optimal myocardial mechanical performance dates back 75 years. Wiggers 1 observed that asynchronous delayed activation of the ventricular musculature induced by electrical stimulation had adverse hemodynamic consequences in mammals, and he proposed that the more muscle activated before excitation of the Purkinje system, the greater the asynchrony and the weaker the resulting contraction. Forty years later, Schlant 2 concluded that asynchronous ventricular activation imposed by LBBB was hemodynamically disadvantageous and coined the term "idioventricular kick" to describe the benefit imparted by coordinated activation. Subsequent studies demonstrated that when one segment of the ventricle, such as the septum, contracts earlier than another segment, such as the lateral wall, the second segment stretches, absorbing some of the initial force, and then begins its late contraction, stretching the first segment. 3,4 The resulting contraction is mechanically inefficient, with diminished ejection at an increased metabolic cost. Reductions of myocardial blood flow and wall thickness occur in the region of early activation, a remodeling effect that could theoretically contribute to progression of heart failure. 5,6 See p 1741 In 1984, de Teresa et al 7 demonstrated that changing the sequence of ventricular activation by pacing could improve cardiac function. Pacing from epicardial leads placed on the right atrium and lateral left ventricular (LV) free wall in patients with LBBB after aortic valve replacement, they noted that left ventricular ejection fraction was maximal when septal and free wall contraction were simultaneous and diminished when septal and free wall motion were dyssynchronous. Ten years later, Cazeau and colleagues 8 applied the term "cardiac resynchronization" to the favorable modification of cardiac activation sequence by pacing in patients with cardiomyopathy and LBBB.Early attempts at epicardial LV pacing via the coronary veins using pacing leads designed for the right ventricular (RV) apex or left atrium via the coronary sinus met with difficult lead placement and instability and high pacing thresholds. 9 With the development of pacing systems designed for the task, progress has been swift. A meta-analysis of randomized trials of cardiac resynchronization therapy (CRT) using these first generation pacing systems in 1634 patients found that heart failure deaths were reduced by 51% (from 3.5% to 1.7%) and heart failure hospitalizations were reduced by 29%. 10 The demonstrated benefit is remarkable in view of the failure of approximately 20% to 30% of pat...

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“…Chronic benefit includes reverse remodeling (21)(22)(23)(24)(25), improved LV function and decreased myocardial oxygen consumption (26). Long term bi-ventricular pacing is associated with a significant reduction in mitral regurgitation jet area (4,27), left ventricular mass, left ventricular end-systolic and end-diastolic dimensions of all indicative reverse remodeling (28)(29)(30).…”

Section: Chronic Effectsmentioning

confidence: 99%

Cardiac Resynchronisation Therapy in Heart Failure

Wahab¹,

Alvi²,

Panwar³

et al. 2011

Int Cardiovasc Res J

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This review is intended for those managing patients of heart failure and aims to provide the recent advances and emerging role of CRT implantation in heart failure management.Cardiac resynchronization therapy (CRT) represents one of the recent advances in heart failure (HF) management. It implies an attempt to establish left ventricular synchronous contraction in order to improve left ventricular hemodynamics; thereby improving functional class, and quality of life. CRT has come a long way from an incidental treatment modality to an accepted and indicated treatment strategy for patients suffering from severe and chronic heart failure. With its ever increasing use, it is important that we become conversant with its role in the management of heart failure. This article aims to review the evidence for CRT, how CRT benefits patients of heart failure and reveals the indications of CRT implantation in HF patients.

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Midterm Benefits of Left Univentricular Pacing in Patients With Congestive Heart Failure

Cited by 96 publications

References 36 publications

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

Single Site Left Ventricular Pacing for Cardiac Resynchronization

Cardiac Resynchronisation Therapy in Heart Failure

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