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(Circulation. 1999;99:2993-3001.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Pacing Chamber and Atrioventricular Delay on Acute Systolic Function of Paced Patients With Congestive Heart Failure
From the Department of Cardiology, University Hospital, Otto-von-Guericke Universität, Magdeburg, Germany (A.A., H.K.); Department of Cardiology, RWTH University Hospital, Aachen, Germany (C.S.); Department of Cardiology, University Hospital, Münster, Germany (M.B.); Department of Cardiology, University Hospital, Essen, Germany (S.S.); Department of Cardiology, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany (J.V.); Heart Lung Institute, University Hospital Utrecht, The Netherlands (P.B.); Guidant Corporation, St. Paul, Minn (A.K., J.D., R.S., B.T., J.S.); and Guidant Corporation, Brussels, Belgium (T.P.).
Correspondence to Angelo Auricchio, MD, PhD, Department of Cardiology, University Hospital, Leipzigerstraße 44, D-39120 Magdeburg, Germany. E-mail angelo.auricchio{at}medizin.uni-magdeburg.de
Background—Previous studies of pacing therapy for dilated congestive heart failure (CHF) have not established the relative importance of pacing site, AV delay, and patient heterogeneity on outcome. These variables were compared by a novel technique that evaluated immediate changes in hemodynamic function during brief periods of atrial-synchronous ventricular pacing.
Methods and Results—Twenty-seven CHF patients with severe left ventricular (LV) systolic dysfunction and LV conduction disorder were implanted with endocardial pacing leads in the right atrium and right ventricle (RV) and an epicardial lead on the LV and instrumented with micromanometer catheters in the LV, aorta, and RV. Patients in normal sinus rhythm were stimulated in the RV, LV, or both ventricles simultaneously (BV) at preselected AV delays in a repeating 5-paced/15-nonpaced beat sequence. Maximum LV pressure derivative (LV+dP/dt) and aortic pulse pressure (PP) changed immediately at pacing onset, increasing at a patient-specific optimal AV delay in 20 patients with wide surface QRS (180±22 ms) and decreasing at short AV delays in 5 patients with narrower QRS (128±12 ms) (P<0.0001). Overall, BV and LV pacing increased LV+dP/dt and PP more than RV pacing (P<0.01), whereas LV pacing increased LV+dP/dt more than BV pacing (P<0.01).
Conclusions—In this population, CHF patients with sufficiently wide surface QRS benefit from atrial-synchronous ventricular pacing, LV stimulation is required for maximum acute benefit, and the maximum benefit at any site occurs with a patient-specific AV delay.
Key Words: pacing • heart failure • systole • hemodynamics
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 J. Y. Gabor, D. A. Newman, V. Barnard-Roberts, V. Korley, I. Mangat, P. Dorian, and P. J. Hanly Improvement in Cheyne-Stokes respiration following cardiac resynchronisation therapy Eur. Respir. J., July 1, 2005; 26(1): 95 - 100. [Abstract] [Full Text] [PDF]
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G. Lecoq, C. Leclercq, E. Leray, C. Crocq, C. Alonso, C. d. Place, P. Mabo, and C. Daubert Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure Eur. Heart J., June 1, 2005; 26(11): 1094 - 1100. [Abstract] [Full Text] [PDF]
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M. O. Sweeney, A. S. Hellkamp, K. L. Lee, G. A. Lamas, and for the Mode Selection Trial (MOST) Investigators Association of Prolonged QRS Duration With Death in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction Circulation, May 17, 2005; 111(19): 2418 - 2423. [Abstract] [Full Text] [PDF]
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A. Bernheim, P. Ammann, C. Sticherling, P. Burger, B. Schaer, H. P. Brunner-La Rocca, J. Eckstein, S. Kiencke, C. Kaiser, A. Linka, et al. Right Atrial Pacing Impairs Cardiac Function During Resynchronization Therapy: Acute Effects of DDD Pacing Compared to VDD Pacing J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1482 - 1487. [Abstract] [Full Text] [PDF]
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M. Martinelli, R. Costa, S. F. de Siqueira, and J. A. Ramires COMBAT--conventional versus multisite pacing for bradyarrhythmia therapy: rationale of a prospective randomized multicenter study Eur J Heart Fail, March 2, 2005; 7(2): 219 - 224. [Abstract] [Full Text] [PDF]
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H. Mair, J. Sachweh, B. Meuris, G. Nollert, M. Schmoeckel, A. Schuetz, B. Reichart, and S. Daebritz Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 235 - 242. [Abstract] [Full Text] [PDF]
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M. Poullis and M. Shackcloth Coronary grafts flow and cardiac pacing modalities: the importance of the cardiac resynchronisation trials Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 177 - 178. [Full Text] [PDF]
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I. Hay, V. Melenovsky, B. J. Fetics, D. P. Judge, A. Kramer, J. Spinelli, C. Reister, D. A. Kass, and R. D. Berger Short-Term Effects of Right-Left Heart Sequential Cardiac Resynchronization in Patients With Heart Failure, Chronic Atrial Fibrillation, and Atrioventricular Nodal Block Circulation, November 30, 2004; 110(22): 3404 - 3410. [Abstract] [Full Text] [PDF]
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J. J. Bax, G. B. Bleeker, T. H. Marwick, S. G. Molhoek, E. Boersma, P. Steendijk, E. E. van der Wall, and M. J. Schalij Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1834 - 1840. [Abstract] [Full Text] [PDF]
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H. Kanzaki, R. Bazaz, D. Schwartzman, K. Dohi, L. E. Sade, and J. Gorcsan III A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: Insights from mechanical activation strain mapping J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1619 - 1625. [Abstract] [Full Text] [PDF]
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R.A. Bleasdale, M.S. Turner, C.E. Mumford, P. Steendijk, V. Paul, J.V. Tyberg, J.A. Morris-Thurgood, and M.P. Frenneaux Left Ventricular Pacing Minimizes Diastolic Ventricular Interaction, Allowing Improved Preload-Dependent Systolic Performance Circulation, October 19, 2004; 110(16): 2395 - 2400. [Abstract] [Full Text] [PDF]
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P. Palka, A. Lange, J. Atherton, W. J. Stafford, and D. J. Burstow Biventricular diastolic behaviour in patients with hypertrophic and hereditary hemochromatosis cardiomyopathies Eur J Echocardiogr, October 1, 2004; 5(5): 356 - 366. [Abstract] [Full Text] [PDF]
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H. J.J. Wellens Cardiac arrhythmias: The quest for a cure: A historical perspective J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1155 - 1163. [Abstract] [Full Text] [PDF]
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R. R Brandt, J. Sperzel, H. F Pitschner, and C. W Hamm Echocardiographic assessment of mitral regurgitation in patients with heart failure Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D25 - D28. [Abstract] [Full Text] [PDF]
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J. Vogt, J. Heintze, B. Lamp, B. Hansky, and D. Horstkotte Standard haemodynamic measurements Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D29 - D34. [Abstract] [Full Text] [PDF]
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C. Stellbrink, O.-A. Breithardt, and P. Hanrath Technical considerations in implanting left ventricular pacing leads for cardiac resynchronisation therapy Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D43 - D46. [Abstract] [Full Text] [PDF]
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