Right Atrial Pacing Impairs Cardiac Function During Resynchronization Therapy
| Autor: | Matthias Pfisterer, Jens Eckstein, Stefan Osswald, André Linka, Christian Sticherling, Christoph Kaiser, Peter Ammann, Peter Burger, Alain Bernheim, Hans-Peter Brunner-La Rocca, Beat Schaer, Stephanie Kiencke, Peter Buser |
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| Rok vydání: | 2005 |
| Předmět: |
Cardiac function curve
Bradycardia medicine.medical_specialty Heart disease medicine.diagnostic_test business.industry medicine.medical_treatment Cardiomyopathy Cardiac resynchronization therapy Hemodynamics medicine.disease equipment and supplies Internal medicine Heart failure Anesthesia medicine Cardiology cardiovascular system cardiovascular diseases medicine.symptom business Cardiology and Cardiovascular Medicine Electrocardiography |
| Zdroj: | Journal of the American College of Cardiology. 45(9):1482-1487 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2005.01.033 |
| Popis: | Objectives We aimed to compare the hemodynamic effects of right-atrial-paced (DDD) and right-atrial-sensed (VDD) biventricular paced rhythm on cardiac resynchronization therapy (CRT). Background Cardiac resynchronization therapy improves hemodynamics in patients with severe heart failure and left ventricular (LV) dyssynchrony. However, the impact of active right atrial pacing on resynchronization therapy is unknown. Methods Seventeen CRT patients were studied 10 months (range: 1 to 46 months) after implantation. At baseline, the programmed atrioventricular delay was optimized by timing LV contraction properly at the end of atrial contraction. In both modes the acute hemodynamic effects were assessed by multiple Doppler echocardiographic parameters. Results Compared to DDD pacing, VDD pacing resulted in much better improvement of intraventricular dyssynchrony assessed by the septal-to-posterior wall motion delay (VDD 106 ± 83 ms vs. DDD 145 ± 95 ms; p = 0.001), whereas the interventricular mechanical delay (difference between onset of pulmonary and aortic outflow) did not differ (VDD 20 ± 21 ms vs. DDD 18 ± 17 ms; p = NS). Furthermore, VDD pacing significantly prolonged the rate-corrected LV filling period (VDD 458 ± 123 ms vs. DDD 371 ± 94 ms; p = 0.0001) and improved the myocardial performance index (VDD 0.60 ± 0.18 vs. DDD 0.71 ± 0.23; p Conclusions Our findings suggest that avoidance of right atrial pacing results in a higher degree of LV resynchronization, in a substantial prolongation of the LV filling period, and in an improved myocardial performance. Thus, the VDD mode seems to be superior to the DDD mode in CRT patients. |
| Databáze: | OpenAIRE |
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