Alteration of left ventricular performance by left bundle branch block simulated with atrioventricular sequential pacing

Askenazi, Joseph; Alexander, Jay; Koenigsberg, David I.; Belic, Nenad; Lesch, Michael

doi:10.1016/0002-9149(84)90691-x

Cited by 116 publications

(32 citation statements)

References 30 publications

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“…[1][2][3][4][5][6][7] Our data support the previous observations and suggest that LV dyssynchrony plays a role in deteriorating ventricular function in RAP. Such negative consequences may be explained by the fact that RAP produces an electrical activation sequence similar to left bundle branch block.…”

Section: Discussionsupporting

confidence: 88%

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Effect of Left Ventricular Dyssynchrony on Plasma B-Type Natriuretic Peptide Levels in Patients With Long-Term Right Ventricular Apical Pacing

et al. 2008

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SUMMARYRight ventricular apical pacing (RAP) has been reported to have the potential to lead to left ventricular (LV) dyssynchrony and impaired LV function. The plasma level of Btype natriuretic peptide (BNP) is increased in the state of abnormal ventricular wall stretch. Therefore, the aim of the present study was to examine the effect of LV dyssynchrony on BNP levels in patients with chronic RAP.Thirty-four patients (17 women, age 69 ± 11 years) with preserved LV systolic function on permanent RAP (duration, 7.0 ± 4.7 years) underwent conventional echo-Doppler assessment and tissue Doppler imaging. Twenty-two normal subjects (8 women, age 66 ± 9 years) served as controls. The standard deviation (SD) and dispersion of the time-topeak systolic velocity (TPV) among the 6 basal LV segments were used as the indexes of LV dyssynchrony.Compared with control subjects, RAP patients had prolonged TPVs and heterogeneous LV contraction with greater values of TPV-SD (18 ± 8 ms versus 39 ± 15 ms, P < 0.001) and TPV-dispersion (42 ± 20 ms versus 93 ± 31 ms, P < 0.001). There were significant correlations between BNP levels and the indexes of LV dyssynchrony (r = 0.41, P = 0.017 for TPV-SD; r = 0.46, P = 0.006 for TPV-dispersion).RAP is associated with LV dyssynchrony, which may accelerate BNP secretion. (Int Heart J 2008; 49: 165-173) Key words: B-type natriuretic peptide (BNP), Tissue Doppler, Dyssynchrony, Echocardiography, Pacing RIGHT ventricular apical pacing (RAP) has been reported to have the potential to lead to left ventricular (LV) dysfunction even in the absence of structural heart disease. Underlying mechanisms of impaired LV function during RAP include alterations of cellular structure and ventricular geometry, systolic and diastolic dysfunction, mitral regurgitation, and increased left atrial diameters.1-5) Systolic dyssynchrony may also play a role in deteriorating LV pump function because From the

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Section: Discussionsupporting

confidence: 88%

“…6,7) On the other hand, the plasma level of B-type natriuretic peptide (BNP) is known to be increased in a state of abnormal ventricular wall stretch. 8,9) We therefore hypothesized that there are some patients who have increased BNP levels resulting from RAP-induced LV dyssynchrony.…”

mentioning

confidence: 99%

Effect of Left Ventricular Dyssynchrony on Plasma B-Type Natriuretic Peptide Levels in Patients With Long-Term Right Ventricular Apical Pacing

et al. 2008

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“…P-сопряженную стиму-ляцию правого желудочка. Хотя этот метод стимуляции облегчает стандартизацию частоты фоновых сокра-щений сердца и обеспечивает надлежащий хроно-метраж МСС, при его воздействии на исходную гемо-динамику пациента проявляются хорошо известные не-гативные воздействия стимуляции правого желудочка, а именно -снижение пикового давления в левом же-лудочке и dP/dt [26].…”

Section: влияние на энергетический обмен миокардаunclassified

Modulation of Cardiac Contractility – a New Method in the Treatment of Heart Failure

Petrukhina

Tereshchenko

Жиров

2016

Racionalʹnaâ farmakoterapiâ v kardiologii

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Российский кардиологический научно-производственный комплекс Россия, 121552, Москва, ул. 3-я Черепковская, 15а Обзор анализирует новый метод лечения больных c хронической сердечной недостаточностью (ХСН) и низкой фракцией выброса -мо-дуляцию сердечных сокращений (МСС). МСС осуществляется за счет подачи электрических импульсов в абсолютно рефрактерный мио-кард желудочков, что приводит к положительному инотропному эффекту без увеличения потребности миокарда кислородом. Исполь-зование метода не зависит от длительности комплекса QRS, следовательно, может быть показана пациентам, не подходящим для про-ведения сердечной ресинхронизирующей терапии (СРТ). Следует отметить, что применение МСС для лечения ХСН должно начинать-ся только на фоне максимально активной терапии при ее недостаточной эффективности. Это не альтернатива, а дополнение к макси-мально активной терапии больных. Клинические исследования в первую очередь нацелены на пациентов с нормальной длительностью QRS ввиду того, что СРТ является оптимальной возможностью лечения пациентов с удлиненным QRS. Обсуждаются результаты, полученные при оценке клинической эффективности и безопасности лечения больных ХСН (n=617) в рандомизированных клинических исследо-ваниях FIX-HF-3 (n=25), FIX-HF-4 (n=164), FIX-HF-5 (n=428). Исходные характеристики пациентов были аналогичны для всех 3-х ис-следований. Все участники получали оптимальную медикаментозную терапию, имели нормальную длительность QRS. Все пациенты были II и III функционального класса (по NYHA). В исследованиях проводился анализ изменений функционального класса NYHA, фракции выброса, пикового потребления кислорода (VO 2 ), предшественника мозгового натрийуретического пептида (NT-proBNP). Проводилась оценка качества жизни по результатам Миннесотского опросника, уровень смертности сравнивался с прогнозируемым по шкале MAGGIC. МСС благоприятно влияла на выживаемость и качество жизни пациентов. Однако для оценки долгосрочных эффектов от про-ведения МСС требуется больше данных.Ключевые слова: хроническая сердечная недостаточность, имплантируемые устройства, модуляция сердечной сократимости. The review analyzes new treatment for patients with chronic heart failure (CHF) with low ejection fraction -cardiac contractility modulation (CCM). CCM is carried out by supplying electric signals to an absolutely refractory ventricular myocardium, to elicit a positive inotropic effect without increasing myocardial oxygen consumption. These effects are independent on QRS duration; consequently, the therapy might be beneficial for patients who are not candidates for cardiac resynchronization therapy (CRT). It should be noted that the use of CCM treatment of CHF should begin only with maximum active therapy when its efficacy is not enough. It is not an alternative, but complement to the most active treatment of patients. Clinical studies primarily focused on patients with normal QRS duration because the CPT is optimal treatment of patients with prolonged QRS. The article focuses on the prerequisites for the development of the method ...

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“…3 Although these results could not be reproduced in prospective studies 4,5 and improvements could only be demonstrated short-term in highly selected patients, 6 the race to find a pacing therapy for heart failure had begun. On the hypothesis that the disappointing results of dual-chamber pacing in prospective studies were due to cancelling or overcoming the beneficial effects of AV synchronisation by the adverse effect of RV pacinginduced dyssynchrony, 7,8 Cazeau and colleagues proposed a 4-chamber pacing mode and reported the first successful permanent implant in 1994. 9 Early randomized controlled trials confirmed short-term improvements in functional capacity and quality of life for patients.…”

Section: Crt: From Origins To Routine Clinical Practicementioning

confidence: 99%

Patient Selection and Echocardiographic Assessment of Dyssynchrony in Cardiac Resynchronization Therapy

et al. 2008

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A ppropriate cardiac resynchronization therapy (CRT) enhances quality of life and improves survival in patients with refractory heart failure due to systolic dysfunction and mechanical dyssynchrony. On the assumption that the main therapeutic mechanism of CRT is the correction of dyssynchronous myocardial contraction, imaging-based measures of dyssynchrony have been intensely investigated with the aim of predicting response to therapy. Numerous echocardiographic dyssynchrony parameters have been proposed, but no large prospective trial have been published to prove the clinical utility of any of these indexes. Moreover, the methodology to derive the proposed dyssynchrony indexes has not been standardized. Therefore, the purpose of this article is to critically review the current status of proposed dyssynchrony indexes by echocardiography for patient selection and to recommend future investigations in this area.

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Alteration of left ventricular performance by left bundle branch block simulated with atrioventricular sequential pacing

Cited by 116 publications

References 30 publications

Effect of Left Ventricular Dyssynchrony on Plasma B-Type Natriuretic Peptide Levels in Patients With Long-Term Right Ventricular Apical Pacing

Effect of Left Ventricular Dyssynchrony on Plasma B-Type Natriuretic Peptide Levels in Patients With Long-Term Right Ventricular Apical Pacing

Modulation of Cardiac Contractility – a New Method in the Treatment of Heart Failure

Patient Selection and Echocardiographic Assessment of Dyssynchrony in Cardiac Resynchronization Therapy

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