Atrial dyssynchrony syndrome: an overlooked phenomenon and a potential cause of ‘diastolic’ heart failure

Eicher, Jean‐Christophe; Laurent, Gabriel; Mathe, Anaelle; Barthez, Olivier; Bertaux, Géraldine; Philip, J.; Dorian, Paul; Wolf, Jean-Éric

doi:10.1093/eurjhf/hfr169

Cited by 69 publications

(61 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a series of cases, Eicher et al demonstrated that interatrial mechanical delay was present among 59% of subjects with HF with preserved ejection fraction, but none in control subjects. (79) This led to the proposal of atrial resynchronization therapy for treatment of HFpEF as well as prevention of atrial fibrillation development. (80) Furthermore, Kim et al demonstrated that left ventricular dyssynchrony may also play an important role in diastolic dysfunction, both among those with HF symptoms (HFpEF) and without (PDD).…”

Section: Management Of Pddmentioning

confidence: 99%

Pre-Clinical Diastolic Dysfunction

Wan

Vogel

Chen

2014

Journal of the American College of Cardiology

286

200

View full text Add to dashboard Cite

Preclinical Diastolic Dysfunction (PDD) has been broadly defined as subjects with left ventricular diastolic dysfunction, without the diagnosis of congestive heart failure (HF), and with normal systolic function. PDD is an entity which remains poorly understood, yet has definite clinical significance. Although few original studies have focused on PDD, it has been shown that PDD is prevalent, and that there is a clear progression from PDD to symptomatic heart failure including dyspnea, edema, and fatigue. In diabetic patients and patients with coronary artery disease or hypertension, it has been shown that patients with PDD have a significantly higher risk of progression to heart failure and death compared to patients without PDD. Because of these findings and the increasing prevalence of the heart failure epidemic, it is clear that an understanding of PDD is essential to decreasing patients’ morbidity and mortality. This review will focus on what is known concerning preclinical diastolic dysfunction, including definitions, staging, epidemiology, pathophysiology, and the natural history of the disease. In addition, given the paucity of trials focused on PDD treatment, studies targeting risk factors associated with the development of PDD and therapeutic trials for heart failure with preserved ejection fraction will be reviewed.

show abstract

Section: Management Of Pddmentioning

confidence: 99%

Pre-Clinical Diastolic Dysfunction

Wan

Vogel

Chen

2014

Journal of the American College of Cardiology

286

200

View full text Add to dashboard Cite

show abstract

“…Furthermore, atrial dyssynchrony is common in HFpEF. These factors likely contribute to the development of new onset or progression of atrial arrhythmias, a frequent complication of HFpEF [152]. LA function is associated with pulmonary vascular disease and right heart failure in HFpEF, supporting efforts to improve LA function in this cohort [153].…”

Section: Left Atrial Dysfunctionmentioning

confidence: 99%

Heart failure with preserved ejection fraction in the elderly: scope of the problem

Upadhya

Taffet

Cheng

et al. 2015

Journal of Molecular and Cellular Cardiology

120

View full text Add to dashboard Cite

Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults, particularly women, and is increasing in prevalence as the population ages. With morbidity and mortality on par with HF with reduced ejection fraction, it remains a most challenging clinical syndrome for the practicing clinician and basic research scientist. Originally considered to be predominantly caused by diastolic dysfunction, more recent insights indicate that HFpEF in older persons is typified by a broad range of cardiac and non-cardiac abnormalities and reduced reserve capacity in multiple organ systems. The globally reduced reserve capacity is driven by: 1) inherent age-related changes; 2) multiple, concomitant co-morbidities; 3) HFpEF itself, which is likely a systemic disorder. These insights help explain why: 1) comorbidities are among the strongest predictors of outcomes; 2) approximately 50% of clinical events in HFpEF patients are non-cardiovascular; 3) clinical drug trials in HFpEF have been negative on their primary outcomes. Embracing HFpEF as a true geriatric syndrome, with complex, multi-factorial pathophysiology and clinical heterogeneity could provide new mechanistic insights and opportunities for progress in management.

show abstract

“…Both aspects were strongly associated with an increased AF incidence (Table 4), with a low AF occurrence early in the follow-up period in subjects programmed with physiologic pacing (Figure 2). It is known that AV synchrony and avoidance of unnecessary atrial stimulation ensure optimal diastolic filling of the left ventricle [10][11][12] and prevent atrial dyssynchrony, [13][14][15] thereby decreasing AF incidence. Optimization of diastolic filling time is a key factor to ensure clinical response to CRT, 11 but is most frequently disregarded in AVB patients.…”

Section: Mortality and Predictorsmentioning

confidence: 99%

Pacemaker Programming, Physiologic Pacing Settings, and Clinical Outcomes in Real-world Practice: Results from the OPTI-MIND Clinical Study

Biffi¹,

Pelargonio²,

Havlíček³

2016

JICRM

View full text Add to dashboard Cite

ABSTRACT. The aim was to observe the relationship of pacemaker programming and patients' outcome in an unselected population of recipients in real-world practice. Pacemaker programming at hospital discharge and at scheduled follow-up visits was recorded and classified as physiologic based on simple principles: avoidance of unnecessary ventricular stimulation in patients without atrioventricular block, avoidance of unnecessary atrial stimulation in those without sinus node dysfunction, rate increase in those with chronotropic incompetence, and avoidance of hypotension-related symptoms. All-cause 2-year mortality was the primary endpoint; atrial fibrillation (AF) episodes leading to unplanned visits/hospitalizations was the secondary endpoint. A total of 1740 patients were followed for 24 ± 3 months, 89% had DDD(R) pacemakers; physiologic programming was not associated with better survival, but it was associated with a lower incidence of AF episodes in the 810 patients with AV block as primary pacemaker indication (6.5% versus 11%, po0.01). Physiologic pacemaker programming occurred in only 41.4% of patients at hospital discharge; reprogramming towards a physiologic setting occurred in 8.7% at follow-up, mainly (76%) within the first 6 months. Physiologic programming is associated with a lower incidence of AF episodes in AV block patients beyond maintenance of AV synchrony. Proactive pacemaker behavior to increase physiologic programming should be considered, in view of physicians' reluctance to change programming from shipment settings.

show abstract

Atrial dyssynchrony syndrome: an overlooked phenomenon and a potential cause of ‘diastolic’ heart failure

Cited by 69 publications

References 37 publications

Pre-Clinical Diastolic Dysfunction

Pre-Clinical Diastolic Dysfunction

Heart failure with preserved ejection fraction in the elderly: scope of the problem

Pacemaker Programming, Physiologic Pacing Settings, and Clinical Outcomes in Real-world Practice: Results from the OPTI-MIND Clinical Study

Contact Info

Product

Resources

About