Published Online
on May 5, 2003

A more recent version of this article appeared on May 13, 2003

This Article Full Text (PDF) All Versions of this Article: 107/18/2287    most recent 01.CIR.0000070930.33499.9Fv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dubin, A. M. Articles by Rosenthal, D. N. Search for Related Content PubMed PubMed Citation Articles by Dubin, A. M. Articles by Rosenthal, D. N. Related Collections Congestive Pacemaker Pediatric and congenital heart disease, including cardiovascular surgery

Submitted on February 13, 2003
Revised on March 25, 2003
Accepted on March 26, 2003

Electrical Resynchronization. A Novel Therapy for the Failing Right Ventricle

Anne M. Dubin MD^*, Jeffrey A. Feinstein MD, V. Mohan Reddy MD, Frank L. Hanley MD, George F. Van Hare MD, and David N. Rosenthal MD

From the Departments of Pediatrics (A.M.D., J.A.F., G.F.V.H., D.N.R.) and Cardiothoracic Surgery (V.M.R., F.L.H.), Stanford University, Stanford, Calif.

^* To whom correspondence should be addressed. E-mail: amdubin{at}leland.stanford.edu.

Background--Many patients with congenital heart disease develop right ventricular (RV) failure due to anatomy and prior therapy. RV problems may include right bundle-branch block (RBBB), volume loading, and chamber enlargement. Because the failing RV may have regional dyskinesis, we hypothesized that resynchronization therapy might augment its performance.

Methods and Results--We studied 7 patients with RV dysfunction and RBBB, using a predefined pacing protocol. QRS duration, cardiac index (CI), and RV dP/dt were measured in 4 different pacing states. Atrioventricular pacing improved CI and RV dP/dt_max and decreased QRS duration as compared with atrial pacing or sinus rhythm.

Conclusions--Atrioventricular pacing in patients with RBBB and RV dysfunction augments RV and systemic performance. RV resynchronization is a promising novel therapy for patients with RV failure.

Key words: pacing • heart defects, congenital • heart failure

This article has been cited by other articles:

				M. L. Handoko, R. R. Lamberts, E. M. Redout, F. S. de Man, C. Boer, W. S. Simonides, W. J. Paulus, N. Westerhof, C. P. Allaart, and A. Vonk-Noordegraaf Right ventricular pacing improves right heart function in experimental pulmonary arterial hypertension: a study in the isolated heart Am J Physiol Heart Circ Physiol, November 1, 2009; 297(5): H1752 - H1759. [Abstract] [Full Text] [PDF]

				E. W.K. Peng, S. Lilley, B. Knight, J. Sinclair, F. Lyall, K. MacArthur, J. C.S. Pollock, and M. H.D. Danton Synergistic interaction between right ventricular mechanical dyssynchrony and pulmonary regurgitation determines early outcome following tetralogy of Fallot repair Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 694 - 702. [Abstract] [Full Text] [PDF]

				S. Nour, G. Wu, Z. Zhensheng, J. C Chachques, A. Carpentier, and D. Payen The Forgotten Driving Forces in Right Heart Failure: New Concept and Device* Asian Cardiovasc Thorac Ann, October 1, 2009; 17(5): 525 - 530. [Abstract] [Full Text] [PDF]

				P. Bordachar, X. Iriart, J. Chabaneix, F. Sacher, S. Lafitte, P. Jais, M. Haissaguerre, J. Clementy, P. Dos Santos, and J.-B. Thambo Presence of ventricular dyssynchrony and haemodynamic impact of right ventricular pacing in adults with repaired Tetralogy of Fallot and right bundle branch block Europace, August 1, 2008; 10(8): 967 - 971. [Abstract] [Full Text] [PDF]

				F. Haddad, R. Doyle, D. J. Murphy, and S. A. Hunt Right Ventricular Function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance, and Management of Right Ventricular Failure Circulation, April 1, 2008; 117(13): 1717 - 1731. [Full Text] [PDF]

				R E Lane, J Mayet, N S Peters, D W Davies, and A W C Chow Comparison of temporary bifocal right ventricular pacing and biventricular pacing for heart failure: evaluation by tissue Doppler imaging Heart, January 1, 2008; 94(1): 53 - 58. [Abstract] [Full Text] [PDF]

				M. J. Byrne, R. H. Helm, S. Daya, N. F. Osman, H. R. Halperin, R. D. Berger, D. A. Kass, and A. C. Lardo Diminished Left Ventricular Dyssynchrony and Impact of Resynchronization in Failing Hearts With Right Versus Left Bundle Branch Block J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1484 - 1490. [Abstract] [Full Text] [PDF]

				A. Uebing, D. G. Gibson, S. V. Babu-Narayan, G. P. Diller, K. Dimopoulos, O. Goktekin, M. S. Spence, K. Andersen, M. Y. Henein, M. A. Gatzoulis, et al. Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot: Implications of Infundibular Disease Circulation, October 2, 2007; 116(14): 1532 - 1539. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Europace, October 1, 2007; 9(10): 959 - 998. [Full Text] [PDF]

				Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Eur. Heart J., September 2, 2007; 28(18): 2256 - 2295. [Full Text] [PDF]

				E. P. Walsh Interventional Electrophysiology in Patients With Congenital Heart Disease Circulation, June 26, 2007; 115(25): 3224 - 3234. [Full Text] [PDF]

				T. A. Quinn, G. Berberian, S. E. Cabreriza, L. J. Maskin, A. D. Weinberg, J. W. Holmes, and H. M. Spotnitz Effects of sequential biventricular pacing during acute right ventricular pressure overload Am J Physiol Heart Circ Physiol, November 1, 2006; 291(5): H2380 - H2387. [Abstract] [Full Text] [PDF]

				G.-P. Diller, D. Okonko, A. Uebing, S. Y. Ho, and M. A. Gatzoulis Cardiac resynchronization therapy for adult congenital heart disease patients with a systemic right ventricle: analysis of feasibility and review of early experience. Europace, April 1, 2006; 8(4): 267 - 272. [Abstract] [Full Text] [PDF]

				P. P. Pham, S. Balaji, I. Shen, R. Ungerleider, X. Li, and D. J. Sahn Impact of Conventional Versus Biventricular Pacing on Hemodynamics and Tissue Doppler Imaging Indexes of Resynchronization Postoperatively in Children With Congenital Heart Disease J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2284 - 2289. [Abstract] [Full Text] [PDF]

				A. M. Dubin Resynchronization in Pediatrics: Who Needs It? J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2290 - 2291. [Full Text] [PDF]

				H J Nesser, O-A Breithardt, and B K Khandheria Established and evolving indications for cardiac resynchronisation Heart, December 1, 2004; 90(suppl_6): vi5 - vi9. [Abstract] [Full Text] [PDF]

				J. Janousek, V. Tomek, V. Chaloupecky, O. Reich, R. A. Gebauer, J. Kautzner, and B. Hucin Cardiac resynchronization therapy: A novel adjunct to the treatment and prevention of systemic right ventricular failure J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1927 - 1931. [Abstract] [Full Text] [PDF]

				J. Janousek, A. M. Dubin, J. A. Feinstein, G. F. Van Hare, D. N. Rosenthal, V. M. Reddy, and F. L. Hanley Electrical Resychronization of Failing Right Ventricle * Response Circulation, January 20, 2004; 109 (2): e5 - e5. [Full Text] [PDF]