Right ventricular apical versus septal pacing: impact on left ventricular synchrony and function

Atteia, I; Alazab, A; Hussein, Khaled; Abeed, N; Nagi, H Khaled

doi:10.1186/cc10792

Cited by 3 publications

(5 citation statements)

References 22 publications

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“…Cardiac remodelling: In eight studies [2,4,8,15,31,32,37,38], cardiac remodelling was assessed by changes in LV diastolic and systolic volumes measured using LVEDV and LVESV. When the data was pooled across the eight studies, there was a trend towards reduced LV volumes in the RVSP group but the difference was not statistically supported: LVEDV: (SMD, 0.14, 95% CI: -0.16-0.44, p=0.03, I 2 =77.8%) and LVESV: (SMD, 0.02, 95% CI: 0.33-0.38, p=0.90, I 2 =78.6%).…”

Section: Results Of Analysesmentioning

confidence: 99%

“…Lead performance: Lead performance was assessed using QRS duration, R-wave, pacing threshold and impedance. Pooled data from 17 RCTs [2,4,8,15,19,[24][25][26][27][30][31][32][33][34][35][36]38] that provided data on baseline and paced QRS duration revealed at the end of follow-up, the RVAP group had significantly prolonged mean QRS duration compared to the RVSP group (SMD, 1.172, 95% CI: 0.672-1.672, p=0.00) with a high heterogeneity (I 2 =94.34%, p=0.00) (Figure 4). Pooled data from seven studies [4,8,15,24,35,38] reveal the RVSP group had slightly higher mean R-wave (SMD, 0.029, 95% CI: 0.274-0.216), pacing threshold (SMD, 0.149, 95% CI: 0.645-0.348) and impedance (SMD, 0.106, 95% CI: 0.592-0.380) but the difference was not statistically significant (p>0.01).…”

Section: Results Of Analysesmentioning

confidence: 99%

“…Three studies [17,34,36] adopted a crossover design while the remaining adopted a parallel design [1,2,4,5,7,8,15,18,19,[24][25][26][27][28][29][30][31][32][33]36]. Twenty-one studies [1,2,4,5,8,15,[17][18][19][26][27][28][29][30][31][32][33][34][36][37][38] provided LVEF values at baseline and after pacing, eight [2,4,8,15,31,32,37,38] of ...…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Twenty-one studies [1,2,4,5,8,15,[17][18][19][26][27][28][29][30][31][32][33][34][36][37][38] provided LVEF values at baseline and after pacing, eight [2,4,8,15,31,32,37,38] of them reported echocardiographic measures of changes in LV volumes (LVEDV and LVESV) (Table 2). Seventeen studies examined the effect of RVSP and RVAP on QRS [2,4,8,15,19,[24][25][26][27][30][31][32][33][34][35][36]38]. Seven [4,8,15,24,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seventeen studies examined the effect of RVSP and RVAP on QRS [2,4,8,15,19,[24][25][26][27][30][31][32][33][34][35][36]38]. Seven [4,8,15,24,35,38] of the 17 QRS studies also evaluated the effect on R-wave stimulation, pacing threshold and/or impedance (Table 3). Four studies examined tissue Doppler imaging (TDI)-defined LV synchrony [15,31,32,37] (Table 4) .…”

Section: Study Characteristicsmentioning

confidence: 99%

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Right ventricular septal or apical? which is optimal positioning in pacemaker implantation: A systematic review and meta-analysis

Albakri¹,

Bimmel²

2020

Integr Mol Med

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Aims: Right ventricular (RV) apical pacing (RVAP) has been the preferred pacing site for decades but recent evidence suggests chronic RVAP can deteriorate cardiac function. RV septal pacing (RVSP) has emerged as an alternative site but its benefits over RVAP remain unclear. This meta-analysis aims to compare the effect of RVSP and RVAP on cardiac function.Methods: PubMed, EMBASE, and Cochrane were systematically searched for studies examining RVSP and RVAP. The inclusion criteria was randomized clinical trials comparing the effect of RVAP and RVSP on cardiac function and structure at follow-up. Data was pooled using random effects model. Results:Twenty-five studies (N=2,315 patients) randomized into RVAP (n=1,028) and RVSP (n=1,287) were included in this meta-analysis. Pooled data across the studies showed RVSP patients achieved significantly higher mean gain in LVEF at the end of follow-up (standardized mean difference: SMD, 0.394, 95% CI: 0.715-0.073), a narrower QRS duration (SMD, -1.172, 95% CI: 0.672-1.672) and lower levels of serum B-type natriuretic peptide (BNP) (SMD, 0.328, 95% CI: 0.039-0.617, p=0.02). Although RVSP showed a positive trend towards protecting against both LV dyssynchrony and remodelling as well as having better lead performance (R-wave, pacing threshold and impedance), the difference was not significant (p>0.01). Conclusion:In patients with significantly impaired LV systolic function who are eligible for RV pacing, RVSP may improve their LV function and lower serum BNP levels but may not protect them against ventricular dyssynchrony and remodeling.

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Section: Results Of Analysesmentioning

confidence: 99%

Section: Results Of Analysesmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Right ventricular septal or apical? which is optimal positioning in pacemaker implantation: A systematic review and meta-analysis

Albakri¹,

Bimmel²

2020

Integr Mol Med

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Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study)

Tazarourte

Riou

Tremey

et al. 2014

Ann. Fr. Med. Urgence

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Évolution dans la prise en charge des accidents hémorragiques liés aux antivitamines K et traités par du concentré de complexes prothrombiniques : la gestion du traitement médicamenteux par les urgentistes s’est-elle améliorée au fil du temps ?

Mewasing

Pernet

Gast

et al. 2015

Ann. Fr. Med. Urgence

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Évolution dans la prise en charge des accidents hémorragiques liés aux antivitamines K et traités par du concentré de complexes prothrombiniques : la gestion du traitement médicamenteux par les urgentistes s'est-elle améliorée au fil du temps ?Has the management of bleeding related to VKA, and treated with prothrombin complex concentrate, improved over time in emergency departments?Abstract Aims: Bleeding is a serious and potentially fatal complication of VKA, and represents in France, the main cause of hospitalisations for severe iatrogenic accidents. The aim of our study was to assess the compliance of the French guidelines for the management of patients, treated with prothrombin complex concentrate (PCC) for severe hemorrhage associated with VKA, over time in emergency departments (ED). Procedure: This was a two-center observational and retrospective study. Patients who consulted in the ED in 2006, 2009 and 2012 for severe bleeding due to VKA, and who underwent reversal with PCC (centralized orders from the pharmacy), were included. Results: A total of 58 patients met the inclusion criteria. The mean age was 77 years. The leading cause of oral anticoagulation was atrial fibrillation. The main sites of bleeding were abdominal (37%) and intracranial (19%). The average time for PCC prescription was estimated to 146 minutes without any significant change over the time (138 in 2006, concomitantly with PCC in 40 of the 58 included patients (43% in 2006, 80% in 2009 and 68% in 2012). Conclusion: Our results showed no improvement for the management of severe hemorrhage in VKA treated patients over time.

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Right ventricular apical versus septal pacing: impact on left ventricular synchrony and function

Cited by 3 publications

References 22 publications

Right ventricular septal or apical? which is optimal positioning in pacemaker implantation: A systematic review and meta-analysis

Right ventricular septal or apical? which is optimal positioning in pacemaker implantation: A systematic review and meta-analysis

Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study)

Évolution dans la prise en charge des accidents hémorragiques liés aux antivitamines K et traités par du concentré de complexes prothrombiniques : la gestion du traitement médicamenteux par les urgentistes s’est-elle améliorée au fil du temps ?

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