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Developing Clinical Indication for Multisite Pacing

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Abstract

The artificial activation of the heart modifies the mechanics of contraction and relaxation. While only little basic research has been addressed to this question, clinical observations showed that for hypertrophic as well as dilated cardiomyopathies appropriate pacing techniques can be useful.

Pacing can influence the activation sequence. The spread out from a single site is slow, and so hypercontractility deminshed. With the use of multiple electrodes, two atrial and/or two ventricular, conduction delays in the atria or ventricles can be eliminated. Synchronisation of the cardiac activation has an anti-arrhythmic and positiv inotropic effect. This may lead to new indications for pacemakers or better to be named cardiac synchronisers.

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References

  1. Bevegard S, Jonsson B, Karlöf I, Lagergren H, Sowton E. Effect of changes in ventricular rate on cardiac output and central pressures at rest and during exercises in patients with artificial pacemakers. Cardiovasc Res 1967;1:21–33.

    Google Scholar 

  2. Karlöf I, Bevegard S, Ovenfors CO. Adaptation of the left ventricle to sudden changes in heart rate in patients with artificial pacemakers. Cardiovasc Res 1973;7:322–330.

    Google Scholar 

  3. Karlöf I. Haemodynamic effect of atrial triggered versus fixed rate pacing, at rest and during exercise, in complete heart block. Acta Med Scand 1975;197:195–206.

    Google Scholar 

  4. Hassenstein P, Storch HH, Schmitz W. Erfahrungen mit der Schrittmacherdauerbehandlung bei Patienten mit obstruktiver Kardiomyopathie. Thoraxchirurgie Vaskulare Chirurgie 1975;23:496–498.

    Google Scholar 

  5. Jeanrenaud X, Goy JJ, Kappenberger L. Effects of dualchamber pacing in hypertrophic obstructive cardiomyopathy. Lancet 1992;339:1318–1323.

    Google Scholar 

  6. Hochleitner M, Hortnagl H, Hortnagl H, Fridrich L, Gschnitzer F. Long-term efficacy of physiologic dual-chamber pacing in the treatment of end-stage idiopathic dilated cardiomyopathy. Am J Cardiol 1992;70:1320–1325.

    Google Scholar 

  7. Brecker SJ, Xiao HB, Sparrow J, Gibson DG. Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet 1992;340:1308–1311.

    Google Scholar 

  8. Prinzen FW, Augustin CH, Allessie MA, Arts T, Delhaas T, Reneman RS. The time sequence of electrical and mechanical activation during spontaneous beating and ectopic stimulation. Eur Heart J 1992;13:535–543.

    Google Scholar 

  9. Mabo P, Scherlag BJ, Munsif A, Otomo K, Lazzara R. A technique for stable His-bundle recording and pacing: Electrophysiological and haemodynamic correlates. Pacing Clin Electrophysiol 1995;18:1894–1901.

    Google Scholar 

  10. Buckingham TA, Candinas R, Schlaepfer J, Aebischer N, Jeanrenaud X, Landolt J, Kappenberger L. Acute hemodynamic effects of atrioventricular pacing at differing sites in the right ventricle individually and simultaneously. Pacing Clin Electrophysiol 1997;20:909–915.

    Google Scholar 

  11. Nishimura RA, Hayes DL, Holmes DR, Tajik J. Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction: An acute Doppler and catheterization hemodynamic study. J Am Coll Cardiol 1995;25:281–288.

    Google Scholar 

  12. van Oosterhout MFM, Prinzen FW, Arts T, Schreuder JJ, Vanagt WYR, Cleutjens JPM, Reneman RS. Asynchronous electrical activation induces asymetrical hypertrophy of the left ventricular wall. Circulation 1998;98:588–595.

    Google Scholar 

  13. Prinzen FW, Augustin CH, Arts T, Allessie MA, Renemann RS. Redistribution of myocardial fiber strain and blood flow by asynchronous activation. Am J Physiol 1990;254:300–308.

    Google Scholar 

  14. Amitzur G, Manor D, Pressman A, Adam D, Hammerman H, Shofti R, Beyar R, Sideman S. Modulation of the arterial coronary blood flow by asynchronous activation with ventricular pacing. Pacing Clin Electrophysiol 1995;18:697–704.

    Google Scholar 

  15. Cazeau S, Ritter P, Lazzarus A, Gras D, Mugica J. Multisite pacing for congestive heart failure. Pacing Clin Electrophysiol 1996;19:568 (Abstract).

    Google Scholar 

  16. Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Thomsen PE. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994;344: 1523–1528.

    Google Scholar 

  17. Nieslen JC, Andersen HR, Thomsen PEB, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single chamber atrial or ventricular pacing. Circulation 1998;97:987–995.

    Google Scholar 

  18. Saksena S, Prakash A, Hill M, Krol RB, Munsif AN, Mathew PP, Mehra R. Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol 1996;28:687–694.

    Google Scholar 

  19. Daubert C, Gras D, Berder V, Leclercq C, Mabo P. Resynchronisation atriale permanente par la stimulation biatriale synchrone pour le traitement préventif du flutter auriculaire associé à un bloc interauriculaire de haut degré. Arch Mal Cœur 1994;87:1535–1546.

    Google Scholar 

  20. Friedman PA, Hill MRS, Hammill SC, Hayes DL, Stanton MS. Randomized prospective pilot study of long-term dual site atrial pacing for prevention of atrial fibrillation. Mayo Clin Proc 1998;73:848–854.

    Google Scholar 

  21. Delfaut P, Saksena S, Prakash A, Krol RB. Long-term outcome of patientswith drug-refractory atrial flutter and fibrillation after single-and dual-site right atrial pacing for arrhythmia prevention. J Am Coll Cardiol 1998;32:1900–1908.

    Google Scholar 

  22. Prakash A, Delfaut P, Krol RB, Saksena S. Regional right and left atrial activation patterns during single-and dualsite atrial pacing in patients with atrial fibrillation. Am J Cardiol 1998;82:1197–1204.

    Google Scholar 

  23. Gregoratos G, Cheitlin MD, Conill A, Epstein AE, Fellows C, Ferguson TB, Freedman RA, Hlatky MA, Naccarelli GV, Saksena S, Schlant RC, Silka MJ. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol 1998;31:1175–1209.

    Google Scholar 

  24. Gras D, Mabo P, Tang T, Luttikuis O, Chatoor R, Pedersen AK, Tscheliessnigg HH, Deharo JC, Puglisi A, Silvestre J, Kimber S, Ross H, Ravazzi A, Paul V, Skehan D. Multisite pacing as a supplemental treatment of congestive heart failure: Preliminary results of the Medtronic Inc. Insync Study. Pacing Clin Electrophysiol 1998;21:2249–2255.

    Google Scholar 

  25. Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Martensen P, Klein H, for the PATH-CHF Study Group. The pacing therapies for congestive heart failure (PATHCHF) study: Rationale, design, and endpoints of a prospective randomized multicenter study. Am J Cardiol 1999;83:130D-135D.

    Google Scholar 

  26. Kass DA, Chen C-H, Curry C, Talbot M, Berger R, Fetics B, Nevo E. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999;99:1567–1573.

    Google Scholar 

  27. Brecker SJD, Gibson DG. What is the role of pacing in dilated cardiomyopathy? Eur Heart J 1996;17:819–824.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Cardiology, CHUV, Lausanne, Switzerland

    L. Kappenberger

  2. Division of Cardiology, CHUV, Lausanne, Switzerland

    X. Lyon, N. Cox, G. Girod & J. Schlaepfer

Authors
  1. L. Kappenberger
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  2. X. Lyon
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  3. N. Cox
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  4. G. Girod
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  5. J. Schlaepfer
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Kappenberger, L., Lyon, X., Cox, N. et al. Developing Clinical Indication for Multisite Pacing. J Interv Card Electrophysiol 4 (Suppl 1), 87–93 (2000). https://doi.org/10.1023/A:1009882616304

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  • DOI: https://doi.org/10.1023/A:1009882616304

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