Cardiac Resynchronization Therapy Plus Coupled Pacing Improves Acutely Myocardial Function in Heart Failure Patients

Brémont, Camille; Lim, Pascal; Elbaz, Nathalie; Damy, Thibaud; Guéret, Pascal; Dubois‐Randé, Jean‐Luc; Wallick, Don W.; Lellouche, Nicolas

doi:10.1111/pace.12348

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…In patients with heart failure, cardiac resynchronization therapy (CRT) for 6 months was associated with reduced end‐diastolic and end‐systolic volume, reduced LV mass, increased ejection fraction, reduced mitral regurgitant blood flow, and improved myocardial performance index as compared with controls [5–8].…”

Section: Introductionmentioning

confidence: 99%

Comparison of hemodynamic effects of biventricular versus left ventricular only pacing in patients receiving cardiac resynchronization therapy: A before–after clinical trial

Faghfourian

Homayoonfar

Rezvanjoo

et al. 2016

Journal of Arrhythmia

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BackgroundBiventricular (BiV) pacing is the most common mode of delivering cardiac resynchronization therapy (CRT). However, initial clinical studies have indicated that left ventricular (LV) pacing is not inferior to BiV pacing. This study was conducted to address whether LV only pacing can provide the same hemodynamic response as BiV pacing.MethodsThis before–after clinical trial was conducted at Ekbatan Hospital, from July 2012 to November 2014. Patients with a LV ejection fraction ≤35% and a QRS duration ≥0.12 s who had a standard indication for ventricular pacing were enrolled. The CRT devices of all patients had already been set for BiV pacing. Therefore, their CRT devices were set for LV only pacing for 3 months. The hemodynamic status of the patients was assessed by echocardiography before setting the CRT device to LV only pacing (as a control) and 3 months after (as an intervention).ResultsThere was no statistically significant difference between the effect of BiV pacing and LV only pacing on the hemodynamic responses including LV ejection fraction, LV end diastolic and systolic volume, and velocity time integral of the aortic valve. Moreover, no significant difference was seen between men and women either.ConclusionsLV only pacing is not inferior to BiV pacing, and the hemodynamic response was similar in the two groups. However, the LV mode has a number of advantages over the BiV mode. More evidence, based on large clinical trials, is needed to confirm our results.

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Section: Introductionmentioning

confidence: 99%

Comparison of hemodynamic effects of biventricular versus left ventricular only pacing in patients receiving cardiac resynchronization therapy: A before–after clinical trial

Faghfourian

Homayoonfar

Rezvanjoo

et al. 2016

Journal of Arrhythmia

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“…Two studies evaluated the use of coupled pacing in addition to cardiac resynchronisation therapy in heart failure patients with mechanical dyssynchrony 66,67. A further increase in contractility and EF was seen along with a decrease in pulse rate without disrupting the synchronisation properties of CRT.…”

mentioning

confidence: 99%

“…A further increase in contractility and EF was seen along with a decrease in pulse rate without disrupting the synchronisation properties of CRT. While Stegeman et al concluded that this drop in pulse rate reduced the haemodynamic benefit of paired pacing, Brémont et al suggested that the heart rate reduction could have an additional beneficial effect because of increased time for ventricular filling and reduced myocardial work 66,67.…”

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confidence: 99%

Post-extrasystolic Potentiation: Link between Ca2+ Homeostasis and Heart Failure?

Sprenkeler

Vos

2016

Arrhythmia &Amp; Electrophysiology Review

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Post-extrasystolic potentiation (PESP) describes the phenomenon of increased contractility of the beat following an extrasystole and has been attributed to changes in Ca(2+) homeostasis. While this effect has long been regarded to be a normal physiological phenomenon, a number of reports describe an enhanced potentiation of the post-extrasystolic beat in heart failure patients. The exact mechanism of this increased PESP is unknown, but disruption of normal Ca(2+) handling in heart failure may be the underlying cause. The use of PESP as a prognostic marker or therapeutic intervention have recently regained new attention, however, the value of the application of PESP in the clinic is still under debate. In this review, the mechanism of PESP with regard to Ca(2+) in the normal and failing heart will be discussed and the possible diagnostic and therapeutic role of this phenomenon will be explored.

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Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure

Qin

Zhang

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (P<0.01). In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter (LVESd), LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) (P<0.01), but positively with the LVEF (P<0.01). Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV (P<0.01), but negatively with the LVEF (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group (78% sensitivity, 83% specificity), those in QRS-2 group (83% sensitivity, 77% specificity) and in QRS-3 group (89% sensitivity, 79% specificity). In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.

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Cardiac Resynchronization Therapy Plus Coupled Pacing Improves Acutely Myocardial Function in Heart Failure Patients

Abstract: In sinus rhythm HF patients, acute CP application in addition to CRT decreases HR and contributes to myocardial contractility and CO improvement without deleterious impact on ventricular synchronicity.

Cited by 3 publications

References 26 publications

Comparison of hemodynamic effects of biventricular versus left ventricular only pacing in patients receiving cardiac resynchronization therapy: A before–after clinical trial

Comparison of hemodynamic effects of biventricular versus left ventricular only pacing in patients receiving cardiac resynchronization therapy: A before–after clinical trial

Post-extrasystolic Potentiation: Link between Ca2+ Homeostasis and Heart Failure?

Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure

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