Reversal of Pacing-Induced Cardiomyopathy Following Cardiac Resynchronization Therapy

Khurshid, Shaan; Obeng-Gyimah, Edmond; Supple, Gregory E.; Schaller, Robert D.; Lin, David; Owens, Anjali Tiku; Epstein, Andrew E.; Dixit, Sanjay; Marchlinski, Francis E.; Frankel, David S.

doi:10.1016/j.jacep.2017.10.002

Cited by 86 publications

(108 citation statements)

References 16 publications

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“…15,16 Electrical pacing from the right heart compromises the mechanical ventricular efficiency and causes dyssynchrony. 17 In addition, another study reported that the use of CRT was found to be associated with a better LVEF and a smaller LV volume over a 1 year and long-term follow-up period. This is an important reason for the development of PICM after PPM implantation, although the QRS duration derived by electrical pacing does not necessarily reflect the degree of mechanical dyssynchrony.…”

Section: Discussionmentioning

confidence: 99%

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

et al. 2019

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Aims High demand right ventricular pacing may elicit left ventricular systolic dysfunction known as pacing‐induced cardiomyopathy, increasing the risks of heart failure (HF) hospitalization. Percentage of demand ventricular pacing is different between patients with sick sinus syndrome (SSS) and those with complete atrioventricular block (CAVB). This study aims to compare the incidence of HF admission and pacing‐induced cardiomyopathy between patients with SSS and CAVB. Methods and results A total of 824 patients who received single ventricular or dual‐chamber pacemaker implantation at our hospital between January 2003 and December 2012 were recruited for the study. Patients with HF, those without complete cardiac echocardiography, and those with significant coronary artery disease were excluded. Finally, 315 patients with SSS and 289 patients with CAVB were enrolled in this study. The CAVB group had a higher pacing percentage (39.37 ± 9.17% vs. 83.82 ± 33.06%; P < 0.001), longer pacing QRS duration (142.56 ± 33.02 ms vs. 156.63 ± 25.18 ms; P < 0.001), and higher prevalence of follow‐up left ventricular ejection fraction ≤40% (1.3% vs. 4.2%; P = 0.040). However, the incidence of HF admission was similar between the two groups (log‐rank P = 0.647). Age [hazard ratio (HR), 95% confidence interval (CI): 1.121, 1.054–1.193], diabetes mellitus (HR, 95% CI: 2.667, 1.159–6.136), pacing QRS duration ≥163 ms (HR, 95% CI: 3.506, 1.491–8.247), and left atrial size (HR, 95% CI: 1.070, 1.012–1.131) were independent predictors of HF admission. The Kaplan–Meier curve showed a significant difference in HF admission over a 3.5 year follow‐up period (3.5 years: P value = 0.004; 5 years: P value = 0.002) between patients with pacing QRS duration ≥163 and <163 ms. Conclusions There was no difference in HF admission between patients with SSS and CAVB, although the CAVB group had a higher pacing percentage. Post‐pacemaker implant pacing QRS duration ≥163 ms was the most important predictor of HF admission.

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Section: Discussionmentioning

confidence: 99%

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

et al. 2019

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“…* P < 0.05 compared to basal value within treatment groups (paired t test). [Colour figure can be viewed at wileyonlinelibrary.com] ventricles are paced in synchrony, aims to better emulate a physiological cardiac contraction and has demonstrated success in reversing the single-chamber pacing-induced cardiomyopathy (Eldadah et al 2006;Leclercq et al 2007;Bellmann et al 2016;Khurshid et al 2018). Interestingly, it has been observed in a clinical setting, that the functional improvements driven by CRT are more pronounced in individuals starting with asynchronous heart failure (Kirk & Kass, 2013), suggesting the restoration of synchrony has stronger biological effects than continuation of synchrony in heart failure.…”

Section: Clinical Relevancementioning

confidence: 99%

Enhancing respiratory sinus arrhythmia increases cardiac output in rats with left ventricular dysfunction

O’Callaghan

Lataro

Roloff

et al. 2019

The Journal of Physiology

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Key points Respiratory sinus arrhythmia is physiological pacing of the heart that disappears in cardiovascular disease and is associated with poor cardiac prognosis. In heart failure, cardiac pacing has little, if any, variation in rate at rest. We proposed that reinstatement of respiratory sinus arrhythmia would improve cardiac function in rats with heart failure. Heart failure rats were paced daily for 2 weeks with either respiratory sinus arrhythmia or paced monotonically at a matched heart rate; cardiac function was measured using non‐invasive echocardiography. Cardiac output and stroke volume were increased in rats paced with respiratory sinus arrhythmia compared to monotonic pacing, via improvement in systolic function that persisted beyond the pacing treatment period. We propose that respiratory sinus arrhythmia pacing reverse‐remodels the heart in heart failure and is worth considering as a new form of cardiac pacemaking. Abstract Natural pacing of the heart results in heart rate variability, an indicator of good health and cardiac function. A contributor to heart rate variability is respiratory sinus arrhythmia or RSA – an intrinsic respiratory modulated pacing of heart rate. The loss of RSA is associated with poor cardiac prognosis and sudden cardiac death. We tested if reinstatement of respiratory‐modulated heart rate (RMH) would improve cardiac performance in heart failure. Heart failure was induced in Wistar rats by ligation of the left anterior descending coronary artery. Rats were unpaced, monotonically paced and RMH paced; the latter had the same average heart rate as the monotonically paced animals. Cardiac function was assessed non‐invasively using echocardiography before and after 2 weeks of daily pacing at a time when pacing was turned off. RMH increased cardiac output by 20 ± 8% compared to monotonic pacing (−3 ± 5%; P < 0.05). This improvement in cardiac output was associated with an increase in stroke volume compared to monotonic pacing (P = 0.03) and improvement in circumferential strain (P = 0.02). Improvements in ejection fraction (P = 0.08) and surrogate measures of left ventricle compliance did not reach significance. Increases in contractility (P < 0.05) and coronary blood flow (P < 0.05) were seen in vitro during variable pacing to mimic RMH. Thus, in rats with left ventricular dysfunction, chronic RMH pacing improved cardiac function through improvements in systolic function. As these improvements were made with pacing switched off, we propose the novel idea that RMH pacing causes reverse‐remodelling.

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“…48,49 Despite the paucity of large randomized trials there is consensus that upgrading from ventricular pacing to CRT in PICM is beneficial and this is reflected in current guidelines. 44,50 However, the largest randomized trial comparing CRT to RV pacing (the Biopace study), enrolling 1810 patients, showed no significant differences in clinical outcomes, in terms of mortality and heart failure hospitalization. 51…”

Section: Cardiac Resynchronization Therapy (Crt)/biventricular Pacingmentioning

confidence: 99%

The desire for physiological pacing: Are we there yet?

Kaye

2019

Cardiovasc electrophysiol

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Pacing is a well established therapy for bradycardia support and certain types of heart failure. Despite technological advances the optimal pacing lead position remains controversial. Right ventricular pacing, particularly apical has been the site of choice but the induction of abnormal cardiac depolarization and the recognition of an increased risk of impairment of left ventricular systolic function, heart failure and mortality has driven a desire for a true physiological pacing system. A number of different lead positions have been determined and of these His bundle pacing appears to most closely mimic normal ventricular conduction. This article reviews the background to the development of physiological pacing, evaluates historical data for right ventricular pacing and the basis for change and new lead positions.

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Reversal of Pacing-Induced Cardiomyopathy Following Cardiac Resynchronization Therapy

Cited by 86 publications

References 16 publications

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

Enhancing respiratory sinus arrhythmia increases cardiac output in rats with left ventricular dysfunction

The desire for physiological pacing: Are we there yet?

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