Minimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease

Sweeney, Michael O.; Bank, Alan J.; Nsah, Emmanuel; Koullick, Maria; Zeng, Qian; Hettrick, Douglas A.; Sheldon, Todd; Lamas, Gervasio A.

doi:10.1056/nejmoa071880

Cited by 460 publications

(246 citation statements)

References 34 publications

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“…29,30 As a consequence, this should result in a more frequent choice of dual-chamber pacemakers in females, due to the demonstrated harmful effect of ventricular pacing on the outcome of sinus node dysfunction. 31,32 Surprisingly, in the 'real-world', females receive single-chamber devices more frequently. In an analysis on 36,312 elderly Medicare beneficiaries undergoing pacemaker implantation, Lamas et al showed that male gender was an independent predictor of a dual-chamber pacemaker implantation, 33 thus supporting a sex-bias in pacemaker implantation procedures.…”

Section: Permanent Pacemakersmentioning

confidence: 99%

Outcomes in Women Undergoing Electrophysiological Procedures

Biase

Basile

Al‐Ahmad

2013

Arrhythmia &Amp; Electrophysiology Review

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The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.

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Section: Permanent Pacemakersmentioning

confidence: 99%

Outcomes in Women Undergoing Electrophysiological Procedures

Biase

Basile

Al‐Ahmad

2013

Arrhythmia &Amp; Electrophysiology Review

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“…This type of pacing causes an abnormal left ventricular electricalactivation sequence with an electromechanical delay in contraction (right to left ventricle dyssynchrony) and, subsequently, increased mitral regurgitation and decreased EF (17)(18)(19)(20). Several preventive pacing algorithms have been developed to reduce the percentage of right ventricular pacing but these might be used only in patients with sinus node dysfunction, not in patients with advanced AV block and a high percentage of ventricular pacing (21,22). In elderly patients with underlying risk factors for heart failure (diastolic dysfunction and comorbidities), more than 50% of RV apical pacing may trigger the complications (23).…”

Section: Discussionmentioning

confidence: 99%

TUGENDHAT: a pilot randomized study on effects of biventricular pacing in patients with bradycardia pacing indication and normal systolic function on heart failure, atrial fibrillation and quality of life (results of 12 month follow-up)

Táborský

Ríhová²,

Mráz³

et al. 2013

BLL

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Abstract:Background: Since the late 1990s, a growing number of clinical studies have indicated that long-term permanent right ventricular (RV) apical pacing will induce severe complications such as development of heart failure, increased burden of atrial fi brillation leading to decreased quality of life. Aim of the study: To investigate whether cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing can prevent the development of left ventricular (LV) dysfunction, LV remodelling, worsening of the clinical status and quality of life in chronically RV paced patients with normal LV ejection fraction (EF). Methods and results:A total of 127 patients with Class I indication for permanent cardiac pacing and without established indication for CRT were subjected to 6 months of RV and BiV pacing in a patient-blinded, randomized crossover trial. Treatment effects of BiV pacing were evaluated for LV function, LV remodelling and clinical status. Conclusion: BiV pacing, compared to RV pacing, did not change LV function and quality of life in patients with the absence of LV dysfunction or remodelling, standard bradycardia pacing indications in a pilot phase (12-month follow-up) of the TUGENDHAT trial. The fi nal report will be published after 60-month follow-up termination (Tab. 5, Fig. 3, Ref. 30). Full Text in PDF www.elis.sk. Key words: BiV and RV pacing, LV remodelling, heart failure, atrial fi brillation, quality of life. Results of several trials have supported the fact that right ventricular (RV) apical pacing might lead to adverse clinical outcomes in patients with standard pacing indications. Nevertheless, RV apical pacing continues to be practiced by many physicians because of its easy accessibility and relative stability over time (1, 2). The optimal mode and site of pacing remain undefi ned.The detrimental effect of RV pacing is probably most important in patients with pre-existing left ventricular (LV) dysfunction and may lead to worsening of heart failure (3, 4). In RV pacing, the sequence of electrical activation resembles the activation pattern in left bundle branch block (LBBB). This asynchronous electrical pattern is accompanied by abnormal dyssynchronous mechanical interactions within the LV (5). Experimental data suggested that biventricular (BiV) pacing might preserve myocardial performance better than RV apical pacing in patients with atrioventricular (AV) block and normal systolic function (6). The underlying mechanism may be a signifi cant reduction in LV systolic dyssynchrony, as shown by Cojoc et al (7). In the majority of patients with severe LV dysfunction and severe clinical heart failure associated with either LBBB-or RV pacing-induced dyssynchrony, BiV pacing improves clinical status, reduces mortality and morbidity, reduces heart failure (HF) hospitalizations, reverses LV remodelling and improves LV function (8, 9). Therefore, BiV pacing is nowadays recommended in patients with ventricular dyssynchrony (QRS > 120 ms), severe LV dysfunction [LV ejection fraction (LVEF) < 0.35] ...

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“…Доля право-желудочковой стимуляции составила 9,1 и 99,0% соответ-ственно (р<0,001). Не было выявлено различий в частоте госпитализаций по причине декомпенсации ХСН (p=0,62) и смертности (p=0,54) между группами [19].…”

Section: кардиология и сердечно-сосудистая хирургия 1 2015unclassified

Current possibilities of permanent pacing for prevention of atrial fibrillation and heart failure progression

Ivanchina¹,

Kopylov²,

Первова³

et al. 2015

Kardiol. serdechno-sosud. khir.

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Имплантация постоянного электрокардиостимулято-ра (ЭКС) является наиболее эффективным методом лече-ния пациентов с синдромом слабости синусового узла (СССУ) и нарушениями атриовентрикулярного (АВ) про-ведения. Традиционно эндокардиальный электрод им-плантируют в область верхушки правого желудочка (ПЖ), учитывая удобство и быстроту позиционирования, ста-бильность положения электрода [21]. Крупные рандоми-зированные исследования предоставили важную информа-цию об оптимальных режимах стимуляции, а также показа-ли, что правожелудочковая апикальная стимуляция может привести к прогрессированию хронической сердечной не-достаточности (ХСН), развитию наджелудочковых тахиа-ритмий (НЖТ) и увеличению смертности [10,22,27].Неблагоприятные эффекты правожелудочковой апи-кальной стимуляции могут быть объяснены патологиче-ской электрической и механической активацией желудоч-ков (или желудочковой диссинхронией) [26]. Стимуляция из верхушки ПЖ нарушает электрическую и механиче-скую систолу желудочков вследствие изменения не толь-ко нормальной последовательности, но и скорости про-ведения импульса, так как распространение волны воз-буждения через миокард происходит гораздо медленнее, чем через систему Гиса-Пуркинье [21]. Данные измене-ния схожи с патологическими процессами, которые раз-виваются при блокаде левой ножки пучка Гиса [26].Желудочковая диссинхрония может привести к изме-нениям метаболизма и перфузии миокарда, ремоделиро-ванию, а также к нарушению гемодинамики и сократи-тельной функции левого желудочка (ЛЖ) [11,23].В нескольких исследованиях было показано, что по-стоянная правожелудочковая апикальная стимуляция мо-жет ухудшить региональную перфузию миокарда [13,24,25]. Так, дефекты перфузии ЛЖ имелись у 65% пациентов, у большинства из которых по данным ангиографии были выявлены неизмененные коронарные артерии. Дефекты перфузии наиболее часто регистрировались в нижних и апикальных сегментах ЛЖ [24,25]. Наличие дефектов перфузии ассоциировалось с более низкой фракцией вы-броса ЛЖ (ФВЛЖ), а также с большей частотой наруше-ний локальной сократимости, особенно в верхушечных сегментах [13,24,25].Правожелудочковая стимуляция приводит к появле-нию митральной регургитации и ремоделированию лево-го предсердия (ЛП), тем самым увеличивая риск развития фибрилляции предсердий (ФП) [12,14].Крупные клинические рандомизированные исследо-вания [10,18,22,27] показали, что высокий процент пра-вожелудочковой апикальной стимуляции приводит к не-благоприятным клиническим исходам.Так, в исследовании MOST (Mode Selection Trial) оце-нивали результаты изолированной правожелудочковой

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Minimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease

Cited by 460 publications

References 34 publications

Outcomes in Women Undergoing Electrophysiological Procedures

Outcomes in Women Undergoing Electrophysiological Procedures

TUGENDHAT: a pilot randomized study on effects of biventricular pacing in patients with bradycardia pacing indication and normal systolic function on heart failure, atrial fibrillation and quality of life (results of 12 month follow-up)

Current possibilities of permanent pacing for prevention of atrial fibrillation and heart failure progression

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