Ressincronização ventricular: comparando os marcapassos biventriculares com os marcapassos bifocais de ventrículo direito (original) (raw)
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Background: It has been reported that bifocal pacing (BiFP) in the right ventricle (RV) may be an alternative to unsuccessful left ventricular (LV) lead implantation. Aim: This study seeks to assess the improvement in the clinical and hemodynamic parameters after long term BiFP in patients eligible for cardiac resynchronization therapy (CRT), in whom conventional biventricular (BiV) implantation was not feasible or failed. Methods: The three leads (right atrial appendage, RV apex and RV outflow tract) of a BiFP were implanted in 46 patients, among whom16 lost follow up within one month of BiFP implantation, so 30 patients (19 male/11 female) were enrolled in the study with the mean follow up period of 8.7 (± 6.7) months. All patients had heart failure refractory to medical therapy, New York Heart Association (NYHA) functional class of II, III and IV, ejection fraction (EF) ≤ 35 %, left bundle branch block (LBBB) with QRS duration ≥ 130 milliseconds and functional mitral regurgitation. The parameters (QRS duration, NYHA class, EF, and cardiomegaly) were evaluated before and 1, 3, 6, 12 and 24 months after BiFP implantation. A six minute walk test (6MWT) was performed on 7 patients, before and after implantation.
Hospital Chronicles, 2014
A 59-year-old patient with dilated cardiomyopathy, severe systolic left ventricular dysfunction and drug-refractory advanced heart failure (New York Heart Association-NYHA class III-IV symptoms) and prior history of mitral valve replacement was scheduled for implantation of a biventricular pacing system (cardiac resynchronization therapy-defibrillator or CRT-D device). The coronary sinus was cannulated after some effort and a venous coronary angiogram was performed (Panel A). Although a posterolateral cardiac venous branch (Panel A, arrow) was identified to accommodate the left ventricular pacing lead, placement of the lead in this tributary (Panel B) was accompanied by phrenic nerve stimulation, which could not be remedied by moving to more proximal positions where the lead could not be stabilized. Having no other IMAGES IN MEDICINE
Cardiology Journal, 2010
Background: It has been reported that bifocal pacing (BiF) in the right ventricle might be an alternative to unsuccessful left ventricular lead implantation. This case report presents an assessment of the clinical and hemodynamic parameters during a three month follow-up in patients implanted with right ventricular BiF. Methods: Eight patients who underwent unsuccessful left ventricular lead implantation were implanted with a bifocal system in the right ventricular. Leads were implanted in the right atrium appendage, the apex and the right ventricular outflow tract and connected to the cardiac resynchronization therapy pacemaker. All patients performed a sixminute walking test and underwent echocardiography after the implantation and after the three month follow-up. Results: We found a significant performance increase in the six minute walking test and reduction in New York Heart Association class and mitral regurgitation in echocardiography study, as well as a significant increase in left ventricular ejection fraction, and cardiac output directly after the implantation, as well as at threemonth follow-up in patients after BiF implantation. Conclusions: Right ventricular bifocal pacing in patients with cardiac resynchronization therapy indication and unsuccessful left ventricular lead placement seems to be a beneficial treatment for heart failure. Satisfactory hemodynamic and clinical results were observed directly after BiF implantation and during the three month follow-up.
American Heart Journal, 2010
Background Biventricular (BiV) stimulation is the preferred means of delivering cardiac resynchronization therapy (CRT), although left ventricular (LV)-only stimulation might be as safe and effective. B-LEFT HF is a prospective, multicenter, randomized, double-blind study aimed to examine whether LV-only is noninferior to BiV pacing regarding clinical and echocardiographic responses. Methods B-LEFT HF randomly assigned 176 CRT-D recipients, in New York Heart Association class III or IV, with an LV ejection fraction ≤35% and QRS ≥130 milliseconds, to a BiV (n = 90) versus LV (n = 86) stimulation group. Clinical status and echocardiograms were analyzed at baseline and 6 months after CRT-D implant to test the noninferiority of LV-only compared with BiV stimulation. Results The proportion of responders was in line with current literature on CRT, with improvement in heart failure composite score in 76.2% and 74.7% of patients in BiV and LV groups, respectively. Comparing LV versus BiV pacing, the small differences in response rates and corresponding 95% CI indicated that LV pacing was noninferior to BiV pacing for a series of response criteria (combination of improvement in New York Heart Association and reverse remodeling, improvement in heart failure composite score, reduction in LV end-systolic volume of at least 10%), both at intention-to-treat and at per-protocol analysis. Conclusions Left ventricular-only pacing is noninferior to BiV pacing in a 6-month follow-up with regard to clinical and echocardiographic responses. Left ventricular pacing may be considered as a clinical alternative option to BiV pacing.
The efficacy of bifocal right ventricular pacing in CRT for treatment of Heart Failure
Background: It has been reported that bifocal pacing (BiFP) in the right ventricle (RV) may be an alternative to unsuccessful left ventricular (LV) lead implantation. Aim: This study seeks to assess the improvement in the clinical and hemodynamic parameters after long term BiFP in patients eligible for cardiac resynchronization therapy (CRT), in whom conventional biventricular (BiV) implantation was not feasible or failed. Methods: The three leads (right atrial appendage, RV apex and RV outflow tract) of a BiFP were implanted in 46 patients, among whom16 lost follow up within one month of BiFP implantation, so 30 patients (19 male/11 female) were enrolled in the study with the mean follow up period of 8.7 (± 6.7) months. All patients had heart failure refractory to medical therapy, New York Heart Association (NYHA) functional class of II, III and IV, ejection fraction (EF) ≤ 35 %, left bundle branch block (LBBB) with QRS duration ≥ 130 milliseconds and functional mitral regurgitation. The parameters (QRS duration, NYHA class, EF, and cardiomegaly) were evaluated before and 1, 3, 6, 12 and 24 months after BiFP implantation. A six minute walk test (6MWT) was performed on 7 patients, before and after implantation.
Pace-pacing and Clinical Electrophysiology, 2007
There are few studies on cardiac resynchronization therapy (CRT) in heart failure (HF) patients with preexisting right ventricular (RV) pacing. The purpose of this study was to determine the efficacy of CRT upgrading in RV-paced patients and the predictivity of electromechanical dyssynchrony parameters (EDP) evaluated by standard echocardiography (ECHO) and tissue Doppler imaging (TDI). Methods: Thirty-eight consecutive patients with HF [New York Heart Association (NYHA) class III or IV, LVEF < 35%], prior continuous RV pacing, and absence of atrial fibrillation were enrolled in the presence of a paced QRS ≥ 150 ms and evaluated by ECHO and TDI. A responder was defined as a patient with a favorable change in NYHA class and neither HF hospitalization nor death, plus an absolute increase of LVEF ≥ 10 units. Results: At six-months follow-up, the whole study population had significant improvement in symptoms, systolic function, and QRS duration (P < 0.001); 32 (84%) patients had a favorable clinical outcome, 25 (66%) were considered responders according to the previous definition. Postimplant QRS was similarly reduced in both responders and nonresponders, whereas EDP had a significant improvement only in responders (P < 0.05). Using EDP, 23 (79%) patients were responders compared with 2 (22%) patients without mechanical dyssynchrony (P = 0.002). Conclusions: In HF patients with previous RV pacing, CRT is effective to improve clinical, functional outcome, and LV performance and to reduce electromechanical dyssynchrony in a large proportion of patients. Dyssynchrony evaluated by standard and TDI ECHO can be useful for CRT selection of paced patients. (PACE 2007; 30:1096-1104 heart failure, ventricular dyssynchrony, cardiac resynchronization therapy, biventricular upgrading