Τίτλος:
Bifocal right ventricular pacing: An alternative way to achieve resynchronization when left ventricular lead insertion is unsuccessful
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Purpose: Bifocal pacing in the right ventricle is an option for patients with end-stage heart failure in whom biventricular pacing is not possible, due to failure in left ventricular (LV) lead insertion. The purpose of this prospective study was to document the clinical response of these patients, after bifocal pacing. Methods: From the patients referred for cardiac resynchronization therapy (CRT), from 2009 to 2010, 13 cardiac CRT candidates who underwent unsuccessful LV lead implantation were included. The bifocal system's leads were implanted in the right atrium, the right ventricular (RV) apex, and the RV outflow tract. Initial patient assessment and follow-up evaluation after 6 months included clinical criteria, echocardiographic indices, and biochemical parameters. Results: From 13 patients (age 68±9 years, nine male), 10 improved clinically. New York Heart Association classification was reduced by one grade (from 3.6±0.5 to 2.8±0.8, p<0.005 and respectively), while hospitalizations in 6-month time were reduced from three to one (p<0.001). Six-minute walk test (in meters) increased from 176±86 to 297±91 (p<0.001) and quality of life improved (EQ-VAS scale changed from 42±12.5 % to 70.8±20.3 %, p<0.001). Mean shortening in QRS duration was 31.3 ms (from 165.1±16.3 to 133.8±12.7, p<0.001) and B-type natriuretic peptide (in picograms per milliliter) dropped from 834±350 to 621±283 (p<0.001). Ejection fraction (in percent) increased from 27.5±4.6 to 33.3±4.4 (p<0.001), and mitral regurgitation severity decreased by one grade (from 2.7±0.9 to 1.8±0.7, p<0.05). Conclusion: RV bifocal pacing seems to offer a substantial clinical benefit to heart failure patients with traditional CRT indications and could be an alternative option when LV access is unsuccessful. © 2012 Springer Science+Business Media, LLC.
Συγγραφείς:
Sideris, S.
Aggeli, C.
Poulidakis, E.
Gatzoulis, K.
Vlaseros, I.
Avgeropoulou, K.
Felekos, I.
Sotiropoulos, I.
Stefanadis, C.
Kallikazaros, I.
Περιοδικό:
Journal of Interventional Cardiac Electrophysiology
Εκδότης:
Kluwer Academic Publishers
Λέξεις-κλειδιά:
brain natriuretic peptide; lead, adult; aged; article; bifocal right ventricular pacing; blood chemistry; cardiac resynchronization therapy; cardiac resynchronization therapy device; clinical article; clinical assessment; controlled study; disease association; disease severity; echocardiography; electrode; enzyme linked immunosorbent assay; EQ VAS scale; female; follow up; heart failure; heart function test; heart left ventricle; heart left ventricle ejection fraction; heart left ventricle failure; heart pacing; heart right atrium; heart right ventricle; heart right ventricle outflow tract; hospitalization; human; implantation; male; medical documentation; mitral valve regurgitation; priority journal; prospective study; QRS complex; quality of life; Six Minute Walk Test; treatment outcome; treatment response; visual analog scale
DOI:
10.1007/s10840-012-9681-6
