Abstract
Cardiac resynchronization therapy performed with biventricular pacing has been recognized as one of the most promising techniques in the treatment of patients with congestive heart failure [1–3]. Many papers demonstrate significant hemodynamic improvement in patients with severe left ventricular dysfunction and left bundle branch block treated with VDD biventricular pacing and shortened atrioventricular (AV) delays [1–4]. The concept is that biventricular pacing may be an effective pacing modality by synchronizing contraction of the right and left ventricles, leading to improvement of cardiac performance and reduction of mitral régurgitation. Some authors have emphasized the importance of optimization of the stimulation site during ventricular resynchronization therapy and concluded that a posterior/lateral/posterior- lateral left ventricle lead position in combination with a right ventricle apex lead position provides more consistent hemodynamic improvements [5]. Recently published trials have shown a substantial improvement in symptoms, cardiac function, and functional capacity and a less consistent effect on hospitalization, but no convincing evidence for a reduction in cardiac mortality [4]. However, cardiac resynchronization probably is not yet optimal, and many technical and physiopathological concepts are under debate. The subject of this paper is the importance of atrial resynchronization and, consequently, the importance of optimization of the AV delay on both the right and the left sides of the heart.
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References
Blanc JJ, Etienne Y, Gilard M et al (1997) Evaluation of different ventricular pacing sites in patients with severe heart failure. Circulation 93:3273–3277
Leclercq C, Cazeau S, Le Breton H et al (1998) Acute emodynamic effects of biventri-cular DDD pacing in patients with end stage heart failure. J Am Coll Cardiol 32:1825–1831
Auricchio A, Stellbrink C, Block M et al (1999) Effect of pacing chamber and atrio-ventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation 99:2993–3001
Cleland JGF, Ghosh J, Khan NK et al (2003) Multi-chamber pacing: a perfect solution for cardiac mechanical dyssynchrony? Eur Heart J 24:384–390
Auricchio A, Butter C, Stellbrink C et al (2000) Effect of left ventricular stimulation site on the systolic function of heart failure patients during ventricular resynchroni-zation therapy. Pacing Clin Electrophysiol 23(4part II):589 (abstract 147)
Ritter P, Dib JC, Lelievre T et al (1994) Quick determination of the optimal AV delay at rest in patients paced in DDD mode for complete AV block. Eur JCPE 4:A163
Linde C, Leclerq C, Rex S et al (2002) Long-term benefits of biventricular pacing in congestive heart failure: results from the multisite stimulation in cardiomyopathy study. J Am Coll Cardiol 40:111–118
Di Salvo TG, Mathier M, Semigran MJ, Dec GW (1995) Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol 25:1143–1153
De Groote P, Millaire A, Foucher-Hossein C et al (1998) Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol 32:948–954
Ghio S, Gavazzi A, Campana C et al (2001) Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 37:183–188
Porciani M C, Sabini A, Colella A et al (2002) Interatrial septum pacing avoids the adverse effect of interatrial delay in biventricular pacing: an echo Doppler study. Europace 4:317–434
Parravicini U, Mezzani A, Bielli M (2000) DDD pacing and interatrial conduction block: importance of optimal AV interval setting. Pacing Clin Electrophysiol 23:1448–1450
Kindermann M, Schwaab B, Berg M, Fröhling G (2000) The influence of right atrial septal pacing on the interatrial contraction sequence. Pacing Clin Electrophysiol 23:1752–1753
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© 2004 Springer-Verlag Italia
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Di Pede, F., Gasparini, G., Celestre, M., Zuin, G., De Piccoli, B., Raviele, A. (2004). Cardiac Resynchronization Therapy: Is Atrial Resynchronization Important with Biventricular Pacing?. In: Raviele, A. (eds) Cardiac Arrhythmias 2003. Springer, Milano. https://doi.org/10.1007/978-88-470-2137-2_113
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DOI: https://doi.org/10.1007/978-88-470-2137-2_113
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2177-8
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