Optimal Pacing for Right Ventricular and Biventricular Devices

Gillis, Anne M.

doi:10.1161/circep.114.001360

Cited by 27 publications

(5 citation statements)

References 65 publications

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“…18 Based on the results from Mohammed et al, further assessment of the hemodynamic, metabolic, and subcellular influences of atrial arrhythmia and RV apical pacing in this population is also warranted. It is intriguing to consider potential therapeutic intervention targets such as rhythm versus rate control, invasive ablative strategies of arrhythmias, and biventricular or multisite pacing 35 specifically in HFpEF-RVD, on the basis of limited RV metabolic and contractile reserve.…”

Section: Hfpef Phenotypes: Physiological Functional and Structural mentioning

confidence: 99%

It Is Time to Look at Heart Failure With Preserved Ejection Fraction From the Right Side

2014

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Section: Hfpef Phenotypes: Physiological Functional and Structural mentioning

confidence: 99%

It Is Time to Look at Heart Failure With Preserved Ejection Fraction From the Right Side

2014

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“…25 Echocardiographic imaging, most recently using speckle tracking, has been used to identify sites of latest LV mechanical activation. In the Targeted 27 Although these trials demonstrate the promise of this approach to CRT delivery, the increased time associated with screening in this manner and the percentage of patients who cannot undergoing speckle-tracking imaging due to inadequate image quality (11 % in TARGET) 26 have limited its utility.…”

Section: Mechanical Synchronymentioning

confidence: 99%

Developments in Cardiac Resynchronisation Therapy

Lewis

Gold

2015

Arrhythmia &Amp; Electrophysiology Review

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Since the introduction of CRT more than 20 years ago, its role in mild to severe systolic heart failure has become well established.CRT has been shown to decrease mortality, reduce heart failure hospitalisations and improve functional status in patients with NYHA class II-IV heart failure and QRS prolongation, most commonly with LBBB pattern.1 One of the major limitations of CRT implementation is the significant number of 'appropriate' candidates, as determined by guidelines, who fail to respond with clinical, functional or structural endpoints. The rate of non-responders has been estimated between 20 % and 40 %.2 Efforts to predict those patients who will respond to CRT and to optimise the magnitude of response have been important areas of focus with regard to the future of CRT. This article will present recent considerations and advances, both technical and theoretical, in CRT. 3 This trial examined 67 patients with LV ejection fraction (LVEF) ≤35 %, NYHA class III heart failure symptoms, sinus rhythm and QRS duration >150 ms who had biventricular pacemakers placed. The devices were initially programmed to ventricular back-up pacing for rates <40 beats per minute for a period of 3 months followed by reprogramming to encourage biventricular pacing. CRT resulted in significant improvement in 6-minute walk distance, quality of life and peak oxygen uptake as well as decreased hospitalisations. Eighty-five per cent of the study patients reported that they felt better during the period with biventricular pacing programmed on. BackgroundThe Multicentre InSync Randomised Clinical Evaluation (MIRACLE) trial evaluated a similar but much larger patient population. 4 There were 453 patients with NYHA class III-IV heart failure, LVEF ≤35 % and QRS duration ≥130 ms randomised to biventricular or no pacing. Over 6 months of follow-up, significant improvements were noted in 6-minute walk distance, NYHA class and quality of life. Additionally, CRT was an effective adjunct to optimal medical therapy in reducing the secondary combined endpoint of heart failure hospitalisation or death. Although the results of MUSTIC and MIRACLE were encouraging in terms of the clinical benefits of CRT, reduced mortality had not yet been proved. The Comparison of Medical Therapy, Pacing and Defibrillation(COMPANION) trial used a combined primary endpoint of hospitalisation or death from any cause.5 Enrolling 1,520 patients with LVEF ≤35 %, NYHA class III-IV heart failure and QRS duration >120 ms, this trial randomised subjects to optimal medical therapy, medical therapy with a CRT pacemaker (CRT-P) or medical therapy with a CRT defibrillator (CRT-D). At 1 year of follow-up, the CRT-D group showed significant reduction in overall mortality versus medical therapy alone, and the CRT-P group had showed a strong trend for reduced mortality (p=0.059).These results suggested a mortality benefit from CRT even in the absence of defibrillator capabilities.Several studies have since examined the effects of biventricular pacing alone (i.e. CRT-P) on heart fa...

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“…Right ventricular (RV) apex continues to remain as the standard pacing site in the ventricle due to ease of implantation, procedural safety and lack of convincing evidence of better clinical outcomes from non-apical pacing sites. However, several studies have demonstrated the deleterious effects of chronic RV pacing due to dyssynchronous left ventricular (LV) activation and subsequent dysfunction 1 2. Electrical dyssynchrony resulting in abnormal ventricular activation and mechanical dyssynchrony resulting in abnormal ventricular contraction can predispose some patients towards recurrent heart failure hospitalisations (HFHs), atrial arrhythmias and increased mortality 3 4.…”

Section: Introductionmentioning

confidence: 99%

Pacing induced cardiomyopathy: recognition and management

Ponnusamy

Syed

Vijayaraman

2023

Heart

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Right ventricle (RV) apex continues to remain as the standard pacing site in the ventricle due to ease of implantation, procedural safety and lack of convincing evidence of better clinical outcomes from non-apical pacing sites. Electrical dyssynchrony resulting in abnormal ventricular activation and mechanical dyssynchrony resulting in abnormal ventricular contraction during RV pacing can result in adverse LV remodelling predisposing some patients for recurrent heart failure (HF) hospitalisation, atrial arrhythmias and increased mortality. While there are significant variations in the definition of pacing induced cardiomyopathy (PIC), combining both echocardiographic and clinical features, the most acceptable definition for PIC would be left ventricular ejection fraction (LVEF) of <50%, absolute decline of LVEF by ≥10% and/or new-onset HF symptoms or atrial fibrillation (AF) after pacemaker implantation. Based on the definitions used, the prevalence of PIC varies between 6% and 25% with overall pooled prevalence of 12%. While most patients undergoing RV pacing do not develop PIC, male sex, chronic kidney disease, previous myocardial infarction, pre-existing AF, baseline LVEF, native QRS duration, RV pacing burden, and paced QRS duration are the factors associated with increased risk for PIC. While conduction system pacing (CSP) using His bundle pacing and left bundle branch pacing appear to reduce the risk for PIC compared with RV pacing, both biventricular pacing and CSP may be used to effectively reverse PIC.

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Optimal Pacing for Right Ventricular and Biventricular Devices

Cited by 27 publications

References 65 publications

It Is Time to Look at Heart Failure With Preserved Ejection Fraction From the Right Side

It Is Time to Look at Heart Failure With Preserved Ejection Fraction From the Right Side

Developments in Cardiac Resynchronisation Therapy

Pacing induced cardiomyopathy: recognition and management

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