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(Circulation. 1997;96:3273-3277.)
© 1997 American Heart Association, Inc.
Articles |
Evaluation of Different Ventricular Pacing Sites in Patients With Severe Heart Failure
Results of an Acute Hemodynamic Study
From the Department of Cardiology, Brest (France) University Hospital (J.-J.B., Y.E., M.G., J.M., S.M., J.B.) and the Cardiac Arrhythmia Center, University of Minnesota, Minneapolis (D.G.B., K.G.L.).
Correspondence to Jean-Jacques Blanc, MD, Department of Cardiology, University Hospital, Blvd Tanguy Prigent, 29609 Brest Cédex, France.
Background Multisite ventricular pacing has recently been proposed as an additional treatment for patients with severe congestive heart failure. To further assess the potential value of this technique, we compared the acute hemodynamic changes associated with pacing the right ventricular apex (RVA) or outflow tract (RVOT) alone, the left ventricle (LV) alone, or biventricular (BIV) pacing of the RVA and LV together.
Methods and Results Acute hemodynamic findings were measured in 27 patients with severe heart failure despite optimal therapy and either first-degree AV block and/or an intraventricular conduction defect. In the 23 patients with a high pulmonary capillary wedge pressure (PCWP) (>15 mm Hg), data were collected after transvenous pacing at different ventricular sites in either the VDD mode (AV delay=100 ms) or the VVI mode in patients with atrial fibrillation (n=6). The mean baseline cardiac index was 1.82 L · min-1 · m-2. Mean±SD baseline systolic blood pressure (SBP) (118.5±15.2 mm Hg), PCWP (26.4±6.6 mm Hg), and V-wave amplitude (39.1±14.6 mm Hg) were similar before and after either RVA or RVOT pacing. In contrast, LV-based pacing (either LV alone or BIV pacing) resulted in higher SBP (P<.03) and lower PCWP (P<.01) and V-wave amplitude (P<.001) than either baseline or RV pacing measurements. With LV pacing alone, SBP, PCWP, and V waves were 126.5±15.1, 20.7±5.9, and 25.5±8.1 mm Hg, respectively. The results with LV pacing alone were similar to those obtained with BIV pacing.
Conclusions In patients with severe congestive heart failure, both LV pacing alone and BIV pacing resulted in a similar and significant acute improvement in SBP, PCWP, and V-wave amplitude compared with baseline measurements and RV pacing alone. These results provide a strong basis for initiating long-term studies examining the chronic effects of LV-based pacing in patients with medically refractory congestive heart failure.
Key Words: heart failure • pacing • hemodynamics
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M S Turner, R A Bleasdale, C E Mumford, M P Frenneaux, and J A Morris-Thurgood Left ventricular pacing improves haemodynamic variables in patients with heart failure with a normal QRS duration Heart, May 1, 2004; 90(5): 502 - 505. [Abstract] [Full Text] [PDF]
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W. G. Stevenson and M. O. Sweeney Single Site Left Ventricular Pacing for Cardiac Resynchronization Circulation, April 13, 2004; 109(14): 1694 - 1696. [Full Text] [PDF]
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J.-J. Blanc, V. Bertault-Valls, M. Fatemi, M. Gilard, P.-Y. Pennec, and Y. Etienne Midterm Benefits of Left Univentricular Pacing in Patients With Congestive Heart Failure Circulation, April 13, 2004; 109(14): 1741 - 1744. [Abstract] [Full Text] [PDF]
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S. Ghio, C. Constantin, C. Klersy, A. Serio, A. Fontana, C. Campana, and L. Tavazzi Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration Eur. Heart J., April 1, 2004; 25(7): 571 - 578. [Abstract] [Full Text] [PDF]
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S. Lafitte, S. Garrigue, J.-M. Perron, P. Bordachar, S. Reuter, P. Jais, M. Haissaguerre, J. Clementy, and R. Roudaut Improvement of left ventricular wall synchronization with multisite ventricular pacing in heart failure: a prospective study using Doppler tissue imaging Eur J Heart Fail, March 1, 2004; 6(2): 203 - 212. [Abstract] [Full Text] [PDF]
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A. Auricchio and W. T. Abraham Cardiac Resynchronization Therapy: Current State of the Art: Cost Versus Benefit Circulation, January 27, 2004; 109(3): 300 - 307. [Full Text] [PDF]
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E. Puggioni, M. Brignole, M. Gammage, E. Soldati, M. G. Bongiorni, E. N. Simantirakis, P. Vardas, F. Gadler, L. Bergfeldt, C. Tomasi, et al. Acute comparative effect of right and left ventricular pacing in patients with permanent atrial fibrillation J. Am. Coll. Cardiol., January 21, 2004; 43(2): 234 - 238. [Abstract] [Full Text] [PDF]
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D. A. Kass Predicting cardiac resynchronization response by qrs duration: The long and short of it J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2125 - 2127. [Full Text] [PDF]
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Y. Yu, A. Kramer, J. Spinelli, J. Ding, W. Hoersch, and A. Auricchio Biventricular mechanical asynchrony predicts hemodynamic effect of uni- and biventricular pacing Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2788 - H2796. [Abstract] [Full Text] [PDF]
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W. T. Abraham and D. L. Hayes Cardiac Resynchronization Therapy for Heart Failure Circulation, November 25, 2003; 108(21): 2596 - 2603. [Full Text] [PDF]
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O. P. Faris, F. J. Evans, A. J. Dick, V. K. Raman, D. B. Ennis, D. A. Kass, and E. R. McVeigh Endocardial versus epicardial electrical synchrony during LV free-wall pacing Am J Physiol Heart Circ Physiol, November 1, 2003; 285(5): H1864 - H1870. [Abstract] [Full Text] [PDF]
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L Bode-Schnurbus, D Bocker, M Block, R Gradaus, A Heinecke, G Breithardt, and M Borggrefe QRS duration: a simple marker for predicting cardiac mortality in ICD patients with heart failure Heart, October 1, 2003; 89(10): 1157 - 1162. [Abstract] [Full Text] [PDF]
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X. A. A. M. Verbeek, K. Vernooy, M. Peschar, R. N. M. Cornelussen, and F. W. Prinzen Intra-ventricular resynchronization for optimal left ventricular function during pacing in experimental left bundle branch block J. Am. Coll. Cardiol., August 6, 2003; 42(3): 558 - 567. [Abstract] [Full Text] [PDF]
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P Schuster, S Faerestrand, and O-J Ohm Colour tissue velocity imaging can show resynchronisation of longitudinal left ventricular contraction pattern by biventricular pacing in patients with severe heart failure Heart, August 1, 2003; 89(8): 859 - 864. [Abstract] [Full Text] [PDF]
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G. P. Walcott, S. B. Melnick, C. R. Killingsworth, W. M. Smith, and R. E. Ideker Effects of burst stimulation during ventricular fibrillation on cardiac function after defibrillation Am J Physiol Heart Circ Physiol, July 11, 2003; 285(2): H766 - H774. [Abstract] [Full Text] [PDF]
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T. V. Salukhe, M. Y. Henein, and R. Sutton Pacing in heart failure: patient and pacing mode selection Eur. Heart J., June 1, 2003; 24(11): 977 - 986. [Full Text] [PDF]
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G. B. Perego, R. Chianca, M. Facchini, A. Frattola, E. Balla, S. Zucchi, S. Cavaglia, I. Vicini, M. Negretto, and G. Osculati Simultaneous vs. sequential biventricular pacing in dilated cardiomyopathy: an acute hemodynamic study Eur J Heart Fail, June 1, 2003; 5(3): 305 - 313. [Abstract] [Full Text] [PDF]
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M. Peschar, H. de Swart, K. J. Michels, R. S. Reneman, and F. W. Prinzen Left ventricular septal and apex pacing for optimal pump function in canine hearts J. Am. Coll. Cardiol., April 2, 2003; 41(7): 1218 - 1226. [Abstract] [Full Text] [PDF]
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A. Duncan, D. Wait, D. Gibson, and J.-C. Daubert Left ventricular remodelling and haemodynamic effects of multisite biventricular pacing in patients with left ventricular systolic dysfunction and activation disturbances in sinus rhythm: sub-study of the MUSTIC (Multisite Stimulationin Cardiomyopathies) trial Eur. Heart J., March 1, 2003; 24(5): 430 - 441. [Abstract] [Full Text] [PDF]
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G. Neri, P. Zanco, F. Zanon, and R. Buchberger Effect of biventricular pacing on metabolism and perfusion in patients affected by dilated cardiomyopathy and left bundle branch block: evaluation by positron emission tomography Europace, January 1, 2003; 5(1): 111 - 115. [Abstract] [PDF]
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C. C. de Cock, M. C. Giudici, and J. W. Twisk Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: A quantitative review Europace, January 1, 2003; 5(3): 275 - 278. [Abstract] [Full Text] [PDF]
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S. Cazeau, C. Alonso, G. Jauvert, A. Lazarus, and P. Ritter Cardiac resynchronization therapy Europace, January 1, 2003; 5(s1): S42 - S48. [Abstract] [Full Text] [PDF]
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L. Fauchier, O. Marie, D. Casset-Senon, D. Babuty, P. Cosnay, and J. P. Fauchier Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy: A prognostic study with fourier phase analysis of radionuclide angioscintigraphy J. Am. Coll. Cardiol., December 4, 2002; 40(11): 2022 - 2030. [Abstract] [Full Text] [PDF]
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C. Stellbrink and B. Nowak The importance of being synchronous: on the prognostic value of ventricular conduction delay in heart failure J. Am. Coll. Cardiol., December 4, 2002; 40(11): 2031 - 2033. [Full Text] [PDF]
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M. Brignole A novel use of cardiac pacing to improve cardiac function, quality of life and (hopefully) survival in patients with heart failure and permanent atrial fibrillation Eur. Heart J., November 2, 2002; 23(22): 1732 - 1736. [Full Text] [PDF]
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