Comparison of characteristics in responders versus nonresponders with biventricular pacing for drug-resistant congestive heart failure (original) (raw)
Related papers
Research Square (Research Square), 2020
Background His bundle pacing (HBP) is a physiological alternative to biventricular (BiV) pacing. Our goal was to compare short-term results of both pacing approaches in ventricular rate refractory atrial brillation (AF) patients who underwent atrioventricular node ablation (AVNA). Methods Consecutive symptomatic AF patients with moderately reduced left ventricular (LV) ejection fraction (EF ≥35% and <50%) and narrow QRS (≤120ms) who received HBP in conjunction with AVNA were compared to historical BiV pacing controls. Electrocardiographic, echocardiographic, and clinical data at baseline and 6 months after the procedure were assessed. Results Among 24 patients (age 68.8 ± 6.5 years, 50% female, EF 39.6 ± 4%, QRS 95 ± 10ms) who underwent AVNA, 12 received BiV pacing and 12 HBP. Both pacing modalities had similar acute procedure-related success and complication rates. HBP was superior to BiV pacing in terms of postimplant QRS duration, implantation uoroscopy times, reduction of LV volumes (EDV 127 (86-150) ml vs. 146 (121-190) ml, P = 0.101; ESV 64 (46-81) ml vs. 90 (75-123) ml, P = 0.008) and increase in LVEF (46 (41-55) % vs. 38 (35-42) %, P = 0.005). However, improvement of the New York Heart Association class was similar in both groups. Conclusions In ventricular rate refractory AF patients with moderately reduced EF and narrow QRS undergoing AVNA, HBP could be a conceivable alternative to BiV pacing. Further prospective studies are warranted to address the outcomes between both "ablate and pace" strategies.
European Heart Journal, 2002
One third of chronic heart failure patients have major intraventricular conduction and uncoordinated ventricular contraction. Non-controlled studies suggest that biventricular pacing may improve haemodynamics and well-being by reducing ventricular asynchrony. The aim of this trial was to assess the clinical efficacy and safety of this new therapy in patients with chronic atrial fibrillation. Fifty nine NYHA class III patients with left ventricular systolic dysfunction, chronic atrial fibrillation, slow ventricular rate necessitating permanent ventricular pacing, and a wide QRS complex (paced width >or=200 ms), were implanted with transvenous biventricular-VVIR pacemakers. This single-blind, randomized, controlled, crossover study compared the patients' parameters, as monitored during two 3-month treatment periods of conventional right-univentricular vs biventricular pacing. The primary end-point was the 6-min walked distance, secondary end-points were peak oxygen uptake, quality-of-life, hospitalizations, patients' preferred study period and mortality. Because of a higher than expected drop-out rate (42%), only 37 patients completed both crossover phases. In the intention-to-treat analysis, we did not observe a significant difference. However, in the patients with effective therapy the mean walked distance increased by 9.3% with biventricular pacing (374+/-108 vs 342+/-103 m in univentricular;P =0.05). Peak oxygen uptake increased by 13% (P=0.04). Hospitalizations decreased by 70% and 85% of the patients preferred the biventricular pacing period (P<0.001). As compared with conventional VVIR pacing, effective biventricular pacing seems to improve exercise tolerance in NYHA class III heart failure patients with chronic atrial fibrillation and wide paced-QRS complexes. Further randomized controlled studies are required to definitively validate this therapy in such patients.
Journal of the American College of Cardiology, 2004
OBJECTIVES We tested the hypothesis that left ventricular (LV) pacing is superior to right ventricular (RV) apical pacing in patients undergoing atrioventricular (AV) junction ablation and pacing for permanent atrial fibrillation. BACKGROUND The potential benefit of LV over RV pacing needs to be evaluated without the confounding effect of other variables that can influence cardiac performance. METHODS An acute intrapatient comparison of the QRS width and echocardiographic parameters between RV versus LV pacing was performed within 24 h after ablation in 44 patients. Both modes of pacing were also compared with pre-implantation values. RESULTS Compared with RV pacing, LV pacing caused a 5.7% increase in the ejection fraction (EF) and a 16.7% decrease in the mitral regurgitation (MR) score; the QRS width was 4.8% shorter with LV pacing. Similar results were observed in patients with or without systolic dysfunction and/or native left bundle branch block, except for a greater improvement in MR in the latter group. Compared with pre-ablation measures, the EF increased by 11.2% and 17.6% with RV and LV pacing, respectively; the MR score decreased by 0% and 16.7%; and the diastolic filling time increased by 12.7% and 15.6%. CONCLUSIONS Rhythm regularization achieved with AV junction ablation improved EF with both RV and LV pacing; LV pacing provided an additional modest but favorable hemodynamic effect, as reflected by a further increase of EF and reduction of MR. The effect seems to be equal in patients with both depressed and preserved systolic functions and in those with and without native left bundle branch block.
European heart journal, 2018
We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS. We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Signi...
Beneficial Effects of Biventricular Pacing in Patients with a "Narrow" QRS
Pacing and Clinical Electrophysiology, 2003
GASPARINI, M., ET AL.: Beneficial Effects of Biventricular Pacing in Patients with a "Narrow" QRS. Congestive heart failure (CHF) patients with LBBB and QRS duration >150 ms are considered the best candidates to biventricular pacing (Biv-P). However, patients with a narrow (120-150 ms) QRS may also benefit from Biv-P since true ventricular dyssynchrony may be underestimated by considering only QRS enlargement. From October 1999 to April 2002 CHF patients (121 men, mean age 65 years, mean LVEF 0.29, mean QRS width 174 ms) underwent successful Biv-P implantation and were then followed for a mean time of 11.2 months. According to basal QRS duration, patients were divided in two groups, with wide QRS (≥150 ms, 128 patients, 81%) and with narrow QRS (<150 ms, 30 patients, 19%). In the wide QRS group, LVEF improved from 29% to 39% (P < 0.0001), 6-minute walk test from 311 to 463 m (P < 0.0001), while NYHA Class III-IV patients decreased from 86% to 8% (P < 0.0001). In the narrow QRS group LVEF improved from 30% to 38% (P < 0.0001), 6-minute walk test from 370 to 506 m (P < 0.0001), and NYHA Class III-IV patients decreased from 60% to 0% (P < 0.0001). The data showed that in wide and narrow QRS patients, Biv-P significantly improved clinical parameters (NYHA class, 6-minute walk test, quality-of-life, and hospitalization rate) and main echocardiographic indicators. Furthermore, narrow QRS patients had a better survival rate, rapidly regained left ventricular function, and only a few patients remained in a higher NYHA class during follow-up. These patients should not be excluded "a priori" from cardiac resynchronization therapy. (PACE 2003; 26[Pt. II]:169-174) congestive heart failure, pacing, resynchronization therapy, left ventricular dysfunction
Circulation, 2011
Background— Left ventricular (LV) pacing alone may theoretically avoid deleterious effects of right ventricular pacing. Methods and Results— In a multicenter, double-blind, crossover trial, we compared the effects of LV and biventricular (BiV) pacing on exercise tolerance and LV remodeling in patients with an LV ejection fraction ≤35%, QRS ≥120 milliseconds, and symptoms of heart failure. A total of 211 patients were recruited from 11 centers. After a run-in period of 2 to 8 weeks, 121 qualifying patients were randomized to LV followed by BiV pacing or vice versa for consecutive 6-month periods. The greatest improvement in New York Heart Association class and 6-minute walk test occurred during the run-in phase before randomization. Exercise duration at 75% of peak V o 2 (primary outcome) increased from 9.3±6.4 to 14.0±11.9 and 14.3±12.5 minutes with LV and BiV pacing, respectively, with no difference between groups ( P =0.4327). LV ejection fraction improved from 24.4±6.3% to 31.9±1...
Relief of Drug Refractory Angina by Biventricular Pacing in Heart Failure
Pacing and Clinical Electrophysiology, 2003
GASPARINI, M., ET AL.: Relief of Drug Refractory Angina by Biventricular Pacing in Heart Failure. Since cardiac resynchronization therapy (CRT) improves LV function at the cost of low energetic expenditure, the authors hypothesized that it may increase the threshold of drug refractory angina in selected patients with CHF and CAD who are not amenable to myocardial revascularization. From October 1999 to April 2002 patients with CHF and CAD were treated with CRT. Drug refractory angina occurred nearly daily in 8 of the 75 patients. The mean age of these eight men was 71 years, mean NYHA functional Class 3.4 ± 0.5, mean QRS duration (QRSd) 168 ± 20 ms, and mean left ventricular ejection fraction (LVEF) 0.29 ± 0.4. Diffuse CAD not amenable to myocardial revascularization was confirmed on angiography. At baseline, no patient was able to complete a 6-minute walk test because of angina. In the 6 months before CRT, the mean number of hospitalizations per patient for management of CHF or angina was 3.1 ± 0.3. All patients underwent successful CRT. Mean QRSd decreased to 141 ± 16 ms (P = 0.01 vs baseline). After 9 ± 6.1 months, LVEF increased to 0.317 ± 0.028 (P = 0.03 vs baseline), while the NYHA class decreased to 2.6 ± 0.5 (P = 0.02 vs baseline). All patients also experienced a marked decrease in angina episodes, from a mean of 8.3 ± 11.6 to 0.6 ± 1.3 episodes/week (P < 0.05), and completed a 6-minute walk test, covering a mean distance of 337 ± 68 m (vs 237 ± 136 m at baseline, P = 0.007). No further hospitalization was necessary. The beneficial effects of CRT on overall cardiac function may include a better control of angina in severely symptomatic patients. (Pace 2003; 26[Pt. II]:181-184) heart failure, cardiac resynchronization therapy, biventricular stimulation, angina pectoris, coronary artery disease
The American Journal of Cardiology, 2008
An acute comparative study of right ventricular (RV) pacing and echocardiographically guided cardiac resynchronization pacing (CRP) was performed in patients who underwent "ablate and pace" therapy for permanent atrial fibrillation. It was hypothesized that optimized CRP guided by tissue Doppler echocardiography would exert an additive beneficial hemodynamic effect to that of rate regularization achieved through atrioventricular junction ablation. An acute intrapatient comparison of echocardiographic parameters was performed between baseline preablation values and RV pacing and CRP (performed <24 hours after ablation) in 50 patients. Optimized CRP configuration was defined as the modality of pacing corresponding to that of the shortest intra-left ventricular (LV) delay among simultaneous biventricular pacing, sequential biventricular pacing, and singlechamber pacing. The intra-LV delay was defined as the difference between the longest and the shortest activation time in the six basal segments of the left ventricle. Compared with preablation measures, the ejection fraction increased by 10.8% during RV pacing (19% in patients with intra-LV delays <47.5 ms and 3% in those with intra-LV delays >47.5 ms). Compared with RV pacing, CRP caused a 9.2% increase in the ejection fraction, a 6.8% decrease in LV systolic diameter, and a 17.3% decrease in mitral regurgitation area; LV dyssynchrony was reduced from 52 ؎ 27 to 21 ؎ 12 ms. Similar results were observed in patients with and without depressed systolic function and in patients with and without left bundle branch block. In conclusion, rate regularization achieved through atrioventricular junction ablation and RV pacing provides a favorable hemodynamic effect that is inversely related to the level of LV dyssynchrony. Minimizing LV dyssynchrony by means of optimized CRP yields an additional important benefit.
A pilot experience with permanent biventricular pacing to treat advanced heart failure
American Heart Journal, 2000
at least it cannot correct the marked asynchrony of ventricular activation, contraction, and relaxation, which characterizes a number of patients with chronic left ventricular (LV) systolic dysfunction. Such is the case in particular in patients with intraventricular conduction delay (IVCD). Biventricular pacing (BVP), which simultaneously activates both ventricles, may contribute to correcting the asynchrony and thus improve cardiac performance. Several acute hemodynamic studies have shown that temporary biventricular pacing significantly improved hemodynamics. The aim of this prospective pilot but uncontrolled study was to assess the long-term clinical effects of permanent BVP in patients with drug-refractory heart failure secondary to advanced LV systolic dysfunction and IVCD.