Routine Use of Biventricular Pacing Is Not Warranted for Patients With Heart Block

Arenas, Ivan A.; Jacobson, Jason T.; Lamas, Gervasio A.

doi:10.1161/circep.114.000627

Cited by 3 publications

(3 citation statements)

References 58 publications

(89 reference statements)

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“…Although the clinical effectiveness of CRT is remarkable, there are multiple questions concerning dyssynchrony and CRT that remain ill-defined at present. For example, patient vulnerability to HF progression as a result of iatrogenic RV pacing is variable and optimal management of this problem is controversial 12, 13 . In addition, it is estimated that around 30% of selected patients based on current indications do not benefit from CRT.…”

Section: Introductionmentioning

confidence: 99%

Prominent differences in left ventricular performance and myocardial properties between right ventricular and left ventricular-based pacing modes in rats

Mulla

Etzion

Elyagon

et al. 2017

Sci Rep

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Biventricular pacing is an important modality to improve left ventricular (LV) synchronization and long-term function. However, the biological effects of this treatment are far from being elucidated and existing animal models are limited and demanding. Recently, we introduced an implanted device for double-site epicardial pacing in rats and echocardiographically demonstrated favorable effects of LV and biventricular (LV-based) pacing modes typically observed in humans. Here, this new animal model was further characterized. Electrodes were implanted either on the right atria (RA) and right ventricle (RV) or on the RV and LV. Following recovery, rats were either used for invasive hemodynamic measurements (pressure-volume analysis) or exposed to sustained RV vs. biventricular tachypacing for 3 days. RV pacing compromised, while LV-based pacing modes markedly enhanced cardiac performance. Changes in LV performance were associated with prominent compensatory changes in arterial resistance. Sustained RV tachypacing increased the electrocardiogram QTc interval by 7.9 ± 3.1 ms (n = 6, p < 0.05), dispersed refractoriness between the right and left pacing sites and induced important molecular changes mainly in the early-activated septal tissue. These effects were not observed during biventricular tachypacing (n = 6). Our results demonstrate that the rat is an attractive new model to study the biological consequences of LV dyssynchrony and resynchronization.

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Section: Introductionmentioning

confidence: 99%

Prominent differences in left ventricular performance and myocardial properties between right ventricular and left ventricular-based pacing modes in rats

Mulla

Etzion

Elyagon

et al. 2017

Sci Rep

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“…[28][29][30][31][32][33][34][35][36][37] However, CRT implantations are more expensive, have higher complication rates, and should be reserved for those who are most likely to benefit from it. 28,29,31,32,38 Though the pathophysiology of PICM is instigated by the pacinginduced dyssynchrony, multiple factors contribute to the negative effects. These factors include RV pacing burden and myocardial substrate for deterioration.…”

Section: Clincial Consequenses Of Right Ventricular Pacingmentioning

confidence: 99%

“…However, long-term safety and efficacy need to be established, as challenges including elevated pacing thresholds leading to exit block or premature depletion of the battery and problems with sensing have been observed. 38,[156][157][158] Consequently, widespread use of these implantation strategies may have long prospects and the majority of patients continues to receive conventional pacemaker treatment. Thus, it is important to continue the research on how to improve pacemaker treatment for the benefit of the many patients in a growing pacemaker population.…”

Section: Chapter 7 Conclusion and Perspectivesmentioning

confidence: 99%

Chronic effects of right ventricular pacing: The impact of right ventricular lead position

Fruelund

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Atrioventricular Conduction Abnormalities

Issa¹,

Miller²,

Zipes³

2019

Clinical Arrhythmology and Electrophysiology

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Routine Use of Biventricular Pacing Is Not Warranted for Patients With Heart Block

Cited by 3 publications

References 58 publications

Prominent differences in left ventricular performance and myocardial properties between right ventricular and left ventricular-based pacing modes in rats

Prominent differences in left ventricular performance and myocardial properties between right ventricular and left ventricular-based pacing modes in rats

Chronic effects of right ventricular pacing: The impact of right ventricular lead position

Atrioventricular Conduction Abnormalities

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