Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure

Leclercq, Christophe; Cazeau, Serge; Breton, Hervé; Ritter, Philippe; Mabo, Philippe; Gras, Daniel; Pavin, Dominique; Lazarus, Arnaud; Daubert, Jean‐Claude

doi:10.1016/s0735-1097(98)00492-6

Cited by 470 publications

(261 citation statements)

References 21 publications

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“…17,18 Such observations have suggested that patients with DCM and basal discoordination might benefit from LV or biventricular VDD pacing, and this was recently confirmed. [2][3][4][5] However, the response magnitude varies, highlighting the importance of identifying responsive individuals. 6 The present study is the first to systematically test potential markers of clinical response to pacing.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

et al. 2000

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Background-VDD pacing can enhance systolic function in patients with dilated cardiomyopathy and discoordinate contraction; however, identification of patients likely to benefit is unclear. We tested predictors of systolic responsiveness on the basis of global parameters as well as directly assessed mechanical dyssynchrony. Methods and Results-Twenty-two DCM patients with conduction delay were studied by cardiac catheterization with a dual-sensor micromanometer to measure LV and aortic pressures during sinus rhythm and LV free-wall pacing. Pacing enhanced isovolumetric (dP/dt max ) and ejection-phase (pulse pressure, PP) systolic function by 35Ϯ21% and 16.4Ϯ11%, respectively, and these changes correlated directly (rϭ0.7, Pϭ0.001). %⌬dP/dt max was weakly predicted by baseline QRS (rϭ0.6, PϽ0.02), more strongly by baseline dP/dt max (rϭ0.7, Pϭ0.001), and best by bidiscriminate analysis combining baseline dP/dt max Յ700 mm Hg/s and QRS Ն155 ms to predict %⌬dP/dt max Ն25% and %⌬PP Ն10% (PϽ0.0005, 2 ), with no false-positives. Benefit could not be predicted by %⌬QRS. To test whether basal mechanical dyssynchrony predicted responsiveness to LV pacing, circumferential strains were determined at Ϸ80 sites throughout the LV by tagged MRI in 8 DCM patients and 7 additional control subjects. Strain variance at time of maximal shortening indexed dyssynchrony, averaging 28.0Ϯ7.1% in normal subjects versus 201.4Ϯ84.3% in DCM patients (Pϭ0.001). Mechanical dyssynchrony also correlated directly with %⌬dP/dt max (rϭ0.85, Pϭ0.008). Conclusions-These results show that although mechanical dyssynchrony is a key predictor for pacing efficacy in DCM patients with conduction delay, combining information about QRS and basal dP/dt max provides an excellent tool to identify maximal responders.

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] By providing early stimulation to the otherwise late-activated region, pacing probably improves contractile coordination to enhance ejection. However, the therapy involves an implantable device, making it important to identify patients most likely to benefit.…”

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confidence: 99%

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

et al. 2000

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“…1,2 Such patients frequently have marked mechanical dyssynchrony that is improved by biventricular pacing, 3,4 which augments left ventricular (LV) contractile function. 5,6 Short atrioventricular delay pacing may also reduce presystolic mitral regurgitation.…”

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confidence: 99%

Left Ventricular Pacing Minimizes Diastolic Ventricular Interaction, Allowing Improved Preload-Dependent Systolic Performance

et al. 2004

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Background-Left ventricular (LV) pacing improves hemodynamics in patients with heart failure. We hypothesized that at least part of this benefit occurs by minimization of external constraint to LV filling from ventricular interaction. Methods and Results-We present median values (interquartile ranges) for 13 heart failure patients with LV pacing systems implanted for New York Heart Association class III/IV limitation. We used the conductance catheter method to measure LV pressure and volume simultaneously. External constraint was measured from the end-diastolic pressure-volume relation recorded during inferior vena caval occlusion, during LV pacing, and while pacing was suspended. External constraint to LV filling was reduced by 3.0 (4.6 to 0.6) mm Hg from 4.8 (0.6 to 7.5) mm Hg (PϽ0.01) in response to LV pacing; effective filling pressure (LV end-diastolic pressure minus external constraint) increased by 4.0 (2.2 to 5.8) mm Hg from 17.7 (13.3 to 22.6; PϽ0.01). LV end-diastolic volume increased by 10 (3 to 11) mL from 238 (169 to 295) mL (Pϭ0.01), whereas LV end-systolic volume did not change significantly (Ϫ1 [Ϫ2 to 3] mL from 180 [124 to 236] mL, Pϭ0.97), which resulted in an increase in stroke volume of 11 (5 to 13) mL from 49 (38 to 59) mL (PϽ0.01). LV stroke work increased by 720 (550 to 1180) mL ⅐ mm Hg from 3400 (2110 to 4480) mL ⅐ mm Hg (Pϭ0.01), and maximum dP/dt increased by 120 (2 to 161) mm Hg/s from 635 (521 to 767) mm Hg/s (Pϭ0.03). Conclusions-This study suggests a potentially important mechanism by which LV pacing may produce hemodynamic benefit. LV pacing minimizes external constraint to LV filling, resulting in an increase in effective filling pressure; the consequent increase in LV end-diastolic volume increases stroke volume via the Starling mechanism. (Circulation.

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“…1 It has been recently shown that correcting this condition by biventricular pacing cardiac resynchronization therapy (CRT) could improve NYHA stage, life quality, oxygen uptake, cardiac diameters, ejection fraction, and even prognosis. 2 -4 Central hemodynamics also were shown to improve in acute testings, 5 but no data have been published till now on their long-term course using repeated right heart catheterization.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic changes during cardiac resynchronization therapy

Nägele

Azizi

Castel

2007

Clinical Cardiology

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SummaryCardiac resynchronization therapy (CRT) is a new method for the correction of inter-and/or intraventricular conduction delays of patients with heart failure. The long-term impact of CRT on central hemodynamics is not fully characterized. We performed complete right heart catheterization studies in 31 patients receiving a CRT device pre and 6 months after implantation. Most of the patients improved in their NYHA stage, their LVEF, and in parallel showed reduced right atrial (RA) pulmonary artery (PA) and pulmonary capillary wedge (PCW) pressures and pulmonary vascular resistance both at rest and at 25 watts. In addition, we found a reduction in heart rate accompanied by an increased mean arterial pressure both at rest and at 25 watts. Accordingly, brain natriuretic peptide levels (BNP) were lowered. It was concluded that, besides other well-known effects on ventricular coordination, central hemodynamics after 6 months were improved during CRT.

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Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure

Abstract: This acute hemodynamic study demonstrated that biventricular DDD pacing may significantly improve cardiac performance in patients with IVCB and with severe heart failure, in comparison with intrinsic conduction and single-site RV DDD pacing.

Cited by 470 publications

References 21 publications

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Left Ventricular Pacing Minimizes Diastolic Ventricular Interaction, Allowing Improved Preload-Dependent Systolic Performance

Hemodynamic changes during cardiac resynchronization therapy

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