Long-term improvements in quality of life by biventricular pacing in patients with chronic heart failure: results from the Multisite Stimulation in Cardiomyopathy study ( … (original) (raw)
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Journal of the American College of Cardiology, 2002
The main objective of this study was to assess if the benefits of biventricular (BiV) pacing observed during the crossover phase were sustained over 12 months. BACKGROUND MUltisite STimulation In Cardiomyopathies (MUSTIC) is a randomized controlled study intended to evaluate the effects of BiV pacing in patients with New York Heart Association (NYHA) class III heart failure and intraventricular conduction delay. METHODS Of 131 patients included, 42/67 in sinus rhythm (SR) and 33/64 in atrial fibrillation (AF) were followed up longitudinally at 9 and 12 months by 6-min walked distance, peak oxygen uptake (peak VO 2), quality of life by the Minnesota score, NYHA class, echocardiography, and left ventricular ejection fraction by radionuclide technique. RESULTS At 12 months, all SR and 88% of AF patients were programmed to BiV pacing. Compared with baseline, the 6-min walked distance increased by 20% (SR) (p ϭ 0.0001) and 17% (AF) (p ϭ 0.004); the peak VO 2 by 11% (SR) and 9% (AF); quality of life improved by 36% (SR) (p ϭ 0.0001) and 32% (AF) (p ϭ 0.002); NYHA class improved by 25% (SR) (p ϭ 0.0001) and 27% (AF) (p ϭ 0.0001). The ejection fraction improved by 5% (SR) and 4% (AF). Mitral regurgitation decreased by 45% (SR) and 50% (AF). CONCLUSIONS The clinical benefits of BiV pacing appeared to be significantly maintained over a 12-month follow-up period.
… England Journal of …, 2001
Nine patients were withdrawn from the study before randomization, and 10 failed to complete both study periods. Thus, 48 patients completed both phases of the study. The mean (±SD) distance walked in six minutes was 23 percent greater with active pacing (399±100 m vs. 326±134 m, P<0.001), the qualityof-life score improved by 32 percent (P<0.001), peak oxygen uptake increased by 8 percent (P<0.03), hospitalizations were decreased by two thirds (P<0.05), and active pacing was preferred by 85 percent of the patients (P<0.001).
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.
Arquivos Brasileiros De Cardiologia, 2002
Received for publication on Accepted on Purpose -To analyze the influence of biventricular pacing (BP) on clinical behavior, ventricular arrhythmia (VA) prevalence, and left ventricular ejection fraction (LV EF) by gated ventriculography. Methods -Twenty-four patients with left bundle branch block (LBBB) and NYHA class III and IV underwent pacemaker implantation and were randomized either to the conventional or BP group, all receiving BP after 6 months. Results -Sixteen patients were in NYHA class IV (66.6%) and 8 were in class III (33.4%). After 1-year followup, 14 patients were in class II (70%) and 5 were in class III (25%). Two sudden cardiac deaths occurred. A significant reduction in QRS length was found with BP (p=0.006). A significant statistical increase, from a mean of 19.13 ± 5.19% (at baseline) to 25.33 ± 5.90% (with BP) was observed in LVEF Premature ventricular contraction prevalence decreased from a mean of 10,670.00 ± 12,595.39 SD or to a mean of 3,007.00 ± 3,216.63 SD PVC/24 h with BP (p<0.05). Regarding the hospital admission rate over 1 year, we observed a significant reduction from 60. To 16 admissions with BP (p<0.05). Conclusion -Patients with LBBB and severe heart failure experienced, with BP, a significant NYHA class and LVEF improvement. A reduction in the hospital admission rate and VA prevalence also occurred.
2010
The goal of this analysis was to determine the appropriate biventricular pacing target in patients with heart failure (HF). Background Cardiac resynchronization therapy (CRT) decreases the risk of death and HF hospitalization. However, the appropriate amount of biventricular pacing is ill-defined. Methods Mortality and HF hospitalization data from patients undergoing CRT in 2 trials (CRT RENEWAL [Cardiac Resynchronization Therapy Registry Evaluating Patient Response with RENEWAL Family Devices] and REFLEx [ENDOTAK RELIANCE G Evaluation of Handling and Electrical Performance Study]; n ϭ 1,812) were analyzed in a post-hoc fashion. Subjects were grouped based on percent biventricular pacing quartiles with the use of Kaplan-Meier survival analysis.
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.
The American Journal of Cardiology, 1999
Biventricular pacing has recently been proposed for treating patients with drug refractory heart failure and intraventricular conduction delay. The purpose is to restore ventricular relaxation and contraction sequences as homogeneously as possible. The aim of this study was to determine if some factors could predict the long-term clinical effectiveness of that new treatment. This study included 26 patients, aged 66 ؎ 7 years, with drug refractory heart failure and wide QRS. Patients were implanted with a biventricular pacemaker. The left ventricle was paced through a coronary sinus tributary. New York Heart Association functional class, exercise tolerance, and left ventricular (LV) ejection fraction were collected at baseline and after pacemaker implantation. Patients were divided into 2 groups: group I ؍ responders; group II ؍ nonresponders. QRS duration and axis at From the
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2000
Asynchronous patterns of contraction and relaxation may contribute to hemodynamic and functional impairment in heart failure. In 1993, we introduced biventricular pacing as a novel method to treat heart failure by synchronous stimulation of the right and left ventricles after an appropriate atrioventricular delay. The objectives of this study were to assess the early and long-term effects of this therapy on functional capacity and left ventricular function in patients with severe heart failure and left bundle branch block. Twelve patients with end-stage congestive heart failure, sinus rhythm and complete left bundle branch block were treated with biventricular stimulation at optimized atrioventricular delay. The NYHA functional class and maximal bicycle exercise capacity were assessed. Systolic and diastolic left ventricular function were studied with echocardiography and radionuclide angiography. Data was collected at various intervals during 1-year follow-up. Cumulative survival [...
Effect of biventricular pacing on heart rate variability in patients with chronic heart failure
European Journal of Heart Failure, 2003
Background: Biventricular pacing is emerging as a long-term therapy for symptomatic heart failure. Analysis of heart rate variability (HRV) has become an important predictive tool in this syndrome. Aim of the study: To assess whether chronic resynchronization therapy can affect HRV in patients with heart failure. Methods and results: Thirteen patients with heart failure were studied (mean age"1 S.E. 65"2.2 years, QRS 195"5.3 ms, NYHA class 3.2"0.1, LVEF 21"1.7%). The protocol included a preliminary no pacing period for 1 month following device implantation. Twenty-four hour Holter ECG recordings were performed at the end of this period (baseline) and after 3 months of biventricular stimulation (VDD mode). Prior to and following pacing patients underwent NYHA class evaluation, 6-min walk test, Quality of Life Assessment and a cardiopulmonary exercise test. Biventricular pacing improved functional class (P-0.0001) and Quality of life (P-0.0001), increased 6-min walk distance, (Ps0.008) and exercise duration (P-0.0001) but had no significant effect on peak exercise VO . Resynchronization 2 therapy increased mean 24-h RR (922"58 vs. 809"41 ms at baseline, Ps0.006), SDNN (111"11 vs. 83"8 ms, Ps0.003), SDNN-I (56"10 vs. 40"5 ms, Ps0.02), rMSSD (66"14 vs. 41"8 ms, Ps0.003), Total Power (5724"1875 vs. 2074"553 ms , Ps0.03), Ultra Low Frequency Power (1969"789 vs. 653"405 ms , Ps0.03) and Very Low Frequency Power (2407"561 2 2 vs. 902"155 ms , Ps0.004). Conclusion: Biventricular pacing in heart failure improves autonomic function by increasing HRV. 2 This may have important prognostic implications.