Zusammenfassung
The conventional DDD mode of pacing, using the right ventricular (RV) apex as the usual site of depolarization, results in retrograde activation of the left ventricle (LV). This opposite electrical sequence produces deleterious hemodynamic effects as well as the left bundle branch block regularly associated with dilated cardiomyopathy [1]. Optimization of the atrioventricular delay (AVD) provides a better LV filling pattern but does not always compensate RV pacing consequences [2]. Biventricular (BV) pacing was therefore developed to prevent interventricular dyssynchrony and, potentially, intraventricular dyssynchrony. BV pacing was initially demonstrated to provide acute hemodynamic improvement in patients with severe congestive heart failure (CHF) with prolonged QRS duration [3–5]. With BV pacing, the first clinical studies revealed an acute diminution of the capillary wedge pressure associated with an improvement in the cardiac index, suggesting regression of heart failure symptoms. However, potential clinical benefits were only confirmed at a mid-term follow-up.
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References
Rosenquist M, Isaaz K, Botvinik et al (1991) Hemodynamic importance of activation sequence compared to atrioventricualr synchrony in left ventricular function. Am J Cardiol 67:148–156
Nishimura RA, Hayes DL, Holmes DR, Tajik AJ (1995) Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction: an acute Doppler and catheterisation hemodynamic study. J Am Coll Cardiol 25:281–288
Foster AH, Gold MR, McLaughlin JS (1995) Hemodynamic effects of atrio-biventri-cular pacing in humans. Ann Thorac Surg 59:294–300
Cazeau S, Ritter P, Lazarus A et al (1996) Multisite pacing for end-stage heart failure: early experience. Pacing Clin Electrophysiol 19:1748–1757
Leclercq C, Cazeau S, Le Breton H et al (1998) Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J Am Coll Cardiol 32:1825–1831
Leclercq C, Cazeau S, Victor F et al (1998) Long-term results of permanent biventricular pacing in patients with refractory heart failure. Eur Heart J 19:573 (abstr)
Gras D, Mabo P, Tanr T et al (1998) Multisite pacing as a supplemental treatment of congestive heart failure: preliminary results of the Medtronic Inc InSync study. Pacing Clin Electrophysiol 21:2249–2255
Cazeau S, Leclercq C, Lavergne T et al (2001) Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344:873–880
Alonso C, Leclercq C, Victor F et al (1999) Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. Am J Cardiol 84:1417–1421
Leclercq C, Victor F, Alonso C et al (2000) Comparative effects of permanent biventricular pacing for refractory heart failure in patients with stable sinus rhythm or chronic atrial fibrillation. Am J Cardiol 85:1154–1156
Reuter S, Garrigue S, Bordachar P et al (2000) Intermediate-term results of biventricular pacing in heart failure: correlation between clinical and hemodynamic data. Pacing Clin Electrophysiol 23:1713–1717
Jais P, Takahashi A, Garrigue S et al (2000) Mid-term follow up of endocardial biventricular pacing. Pacing Clin Electrophysiol 23:1744–1747
Hochleitner M, Hortnagl H, Fridich L et al (1990) Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy. Am J Cardiol 66:198–202
Garrigue S, Barold SS, Valli N et al (1999) Effect of right ventricular pacing in patients with complete left bundle branch block. Am J Cardiol 83:600–604
Brecker S, Xiao H, Sparrow J, Gibson G (1992) Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet 340:1308–1312
Linde C, Gadler F, Edner M et al (1995) Results of atrioventricular synchronous pacing with optimized delay in patients with severe congestive heart failure. Am J Cardiol 75:919–923
Gold MR, Feliciano Z, Gottlieb SS et al (1995) Dual-chamber pacing with a short atrioventricular delay in congestive heart failure: a randomised study. J Am Coll Cardiol 26:967–973
Blanc J J, Etienne Y, Guard M et al (1997) Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. Circulation 96:3273–3277
Kass DA, Chen CH, Curry C et al (1999) Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 99:1567–1573
Garrigue S, Lafitte S, Hocini M et al (2000) Mechanisms of left ventricular wall resynchronisation during multisite ventricular pacing: direct effects on the variations of the regional electromechanical delays and wall motion velocities. Pacing Clin Electrophysiol 23:682
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© 2002 Springer-Verlag Italia
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Garrigue, S. et al. (2002). What Are the Clinical Benefits of Biventricular Pacing in Heart Failure Patients?. In: Raviele, A. (eds) Cardiac Arrhythmias 2001. Springer, Milano. https://doi.org/10.1007/978-88-470-2103-7_16
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DOI: https://doi.org/10.1007/978-88-470-2103-7_16
Publisher Name: Springer, Milano
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