Prolonged Paced QRS Duration as a Predictor for Congestive Heart Failure in Patients with Right Ventricular Apical Pacing

Miyoshi, Fumito; Kobayashi, Youichi; Itou, Hiroyuki; Onuki, Tatsuya; Matsuyama, Taka‐aki; Watanabe, Norikazu; Liu, Chungchang; Kawamura, Mitsuru; Asano, Taku; Miyata, Akira; Nakagawa, Haruyuki; Tanno, Kaoru; Baba, Takao; Kubo, Takashi

doi:10.1111/j.1540-8159.2005.50181.x

Cited by 67 publications

(40 citation statements)

References 27 publications

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“…The positive effect correlated with reduction of the duration of the QRS complex 7 . In contrast, prolonged paced QRS duration in RVA pacing predicted the development of heart failure 18,19 . Paced QRS duration reflects homogenization of contraction and is a surrogate marker of dyssynchrony of LV contraction.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the pacing site in the ventricular septum by fluoroscopy and morphology of the paced QRS complex

Kameník¹,

Sedloň²,

Hnátek³

et al. 2013

BIOMED PAP

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Aims. To analyze the paced QRS duration in various septal positions of the right ventricular leads and with different paced QRS vectors. To use the results to assess parameters suggesting the optimal site for right ventricular pacing. Methods and Results. A total of 609 patients with leads implanted in the right ventricular septum were classified using fluoroscopy in the lateral view (the primary pacing site), and in the anteroposterior view (the secondary pacing site), according to the QRS vector in leads I and III. Significantly shortened paced QRS was found in the primary pacing site with the true septal compared with the anteroseptal site, with the vector being negative or isoelectric in lead I plus positive in lead III. In secondary pacing sites, no significant difference in pacing QRS duration was found between RVOT-HS, RVOT-LS, mid-septum and inferior-septum. Conclusions. For optimization of the pacing site in the ventricular septum, the following are significant: the primary site based on the lateral view, and the paced QRS vector in leads I and III.

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Section: Introductionmentioning

confidence: 99%

Optimizing the pacing site in the ventricular septum by fluoroscopy and morphology of the paced QRS complex

Kameník¹,

Sedloň²,

Hnátek³

et al. 2013

BIOMED PAP

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“…1,2 It is unclear whether this propensity for deterioration in cardiac function results exclusively from pacing-induced ventricular dyssynchrony or from the interaction of pacing with an abnormal substrate. [1][2][3][4][5][6][7][8][9][10][11] Comorbid illnesses are frequently present in patients with indications for pacemaker implantation. Therefore, the establishment of a cause-and-effect relationship between pacing method and location and pacing-induced cardiac dysfunction continues to be challenging.…”

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confidence: 99%

Effect of Long-Term Right Ventricular Pacing in Young Adults With Structurally Normal Heart

et al. 2010

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Background-Right ventricular pacing increases the risk of heart failure in adults with structural heart disease. The impact of prolonged right ventricular pacing in adults without structural heart disease is not fully characterized and may depend on interactions of pacing with abnormal substrate predisposing to ventricular dysfunction. Methods and Results-We assessed the effect of right ventricular pacing in patients who underwent pacemaker implantation for isolated congenital atrioventricular block between 1964 and 2005. To assess for immunologic contribution to cardiac dysfunction, outcomes were compared between patients with (Ab ϩ ) and without (Ab Ϫ ) antinuclear antibody during adulthood and an age-and sex-matched Olmsted County, Minnesota, population. Of 103 patients (meanϮSD age, 32Ϯ19 years), 18 were Ab

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“…Clinical symptoms of heart failure have been observed in up to 26% of patients who have a normal or reduced LVEF and who subsequently underwent pacemaker implantation with a high percentage of right ventricular pacing 27, 28, 29. However, most of those studies did not have a control group matched for age and cardiovascular comorbid conditions.…”

Section: Discussionmentioning

confidence: 99%

Pacemaker‐Mediated Programmable Hypertension Control Therapy

Neužil

Merkely

Ērglis

et al. 2017

JAHA

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BackgroundMany patients requiring a pacemaker have persistent hypertension with systolic blood pressures above recommended levels. We evaluated a pacemaker‐based Programmable Hypertension Control (PHC) therapy that uses a sequence of variably timed shorter and longer atrioventricular intervals.Methods and ResultsPatients indicated for dual‐chamber pacing with office systolic blood pressure (oSBP) >150 mm Hg despite stable medical therapy were implanted with a Moderato™ pulse generator that delivers PHC therapy. Patients were followed for 1 month (Run‐In period) with conventional pacing; those with persistent oSBP >140 mm Hg were included in the study and had PHC therapy activated. The co‐primary efficacy end points were changes in 24‐hour ambulatory systolic blood pressure and oSBP between baseline and 3 months. Safety was assessed by tracking adverse events. Thirty‐five patients met the initial inclusion criteria and underwent Moderato implantation. At 1 month, oSBP was <140 mm Hg in 7 patients who were excluded. PHC was activated in the remaining 27 patients with baseline office blood pressure 166±11/80±10 mm Hg despite an average of 3.2 antihypertensive medications. During the Run‐In period, oSBP and 24‐hour ambulatory systolic blood pressure decreased by 8±13 and 5±12 mm Hg (P<0.002), respectively. Compared with pre‐PHC activation measurements, oSBP decreased by another 16±15 mm Hg and 24‐hour ambulatory systolic blood pressure decreased by an additional 10±13 mm Hg (both P<0.01) at 3 months. No device‐related serious adverse effects were noted.ConclusionsIn pacemaker patients with persistent hypertension despite medical therapy, oSBP and 24‐hour ambulatory systolic blood pressure are decreased by PHC therapy. Initial indications are that this therapy is a safe and promising therapy for such patients.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02282033.

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Prolonged Paced QRS Duration as a Predictor for Congestive Heart Failure in Patients with Right Ventricular Apical Pacing

Abstract: We concluded that paced QRS duration can be a useful indicator of impaired left ventricular function in patients with RV pacing. Even in patients whose paced QRS duration is relatively shorter, progressive prolongation of paced QRS duration can predict the development of CHF.

Cited by 67 publications

References 27 publications

Optimizing the pacing site in the ventricular septum by fluoroscopy and morphology of the paced QRS complex

Optimizing the pacing site in the ventricular septum by fluoroscopy and morphology of the paced QRS complex

Effect of Long-Term Right Ventricular Pacing in Young Adults With Structurally Normal Heart

Pacemaker‐Mediated Programmable Hypertension Control Therapy

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