Dual-chamber pacing with a short atrioventricular delay in congestive heart failure: A randomized study

Abstract

Dual-chamber pacing with a short AV delay does not improve hemodynamic and clinical status or ejection fraction measured on the day after pacemaker implantation in patients with chronic congestive heart failure. Routine use of pacemaker therapy with a short AV delay aas a primary treatment of heart failure in patients without standard arrhythmic indications is unwarranted.

Biventricular Pacing Decreases Sympathetic Activity Compared With Right Ventricular Pacing in Patients With Depressed Ejection Fraction

“…The interest in conventional short AV delay DDD pacing in patients with heart failure waned as the result of a double-blinded randomized study that showed no immediate improvement in hemodynamics and no longterm change in ejection fraction or NYHA functional class. 11 With failure of conventional DDD pacing to show consistent improvement in hemodynamics in these patients, the interest has shifted to BV pacing.…”

“…[1][2][3] Today, dual chamber pacing is used only for the treatment of symptomatic bradyarrhythmias. On the other hand, preliminary results with biventricular (BV) pacing have shown improvement in New York Heart Association (NYHA) functional class and exercise tolerance in patients with depressed ejection fraction and intraventricular conduction delay.…”

Patient Selection and Echocardiographic Assessment of Dyssynchrony in Cardiac Resynchronization Therapy

“…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.…”

Why Cardiac Resynchronization Therapy (CRT) is Usually Prescribed along with Automatic Implantable Defibrillation (AID)? Is it a Sensible Decision? Historical Perspective

“…Another significant reference is the DAVID Trial [9]. Several other papers appeared about dual-chamber pacing applied to congestive heart failure during the last decade of the former century; in fact and without expressly saying it, all aimed at correcting rightleft ventricular dyssynchrony, but mostly centering the criterion on the A-V delay [10][11][12][13][14][15][16][17][18][19]. Observe that the last reference comes from a multicenter clinical study, and it is over 17-years-old.…”