Journal Article

11. Cardiac Resynchronization Therapy: Different Issues

E. Ammendola, L. Santangelo, C. Savarese, C. Cavallaro, A. D'Onofrio and R. Calabrò

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 7, issue s3, pages S17-S17
Published in print October 2005 | ISSN: 1099-5129
Published online October 2005 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1016/j.eupc.2005.08.156
11. Cardiac Resynchronization Therapy: Different Issues

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Objective

Cardiac resynchronization therapy (CRT) using biventricular pacing has been a major advance in long-term therapy for treatment of congestive heart failure (CHF). Heart rate variability (HRV) analysis has become an important predictive tool in CHF for the effects arrhythmogenic. In our study we observed if CRT can affect HRV in patients with CHF after six months of follow-up.

Methods and Results

20 consecutive patients with CHF (12 men and 8 women; mean age 64.9 ± 11.8, range 48-79 years, NYHA class III-IV, FE<35%, QRS>120 ms., intraventricular and interventricular delay) received biventricular pacing (Guidant Renewal 4). HRV recorded by implanted device and was performed at implantation and six months after procedure. After implantation QRS duration changed from 156 ± 21msec to 132 ± 16msec (p<0.001) and NYHA class decreased in all patients.

HRV improved at follow-up (SDANN 66.8 ± 24.8 vs. 86.6 ± 17.3, p <0.02) with reduction of main heart rate (81.8 ± 7.7 vs. 71.4 ± 4.2, p <0.01). EF improved progressively and were significantly higher at follow-up (24,5±4,15. vs 33,5±9,23, p< 0.05). The LVEDD was significantly smaller than baseline after 6 months (7,41±0.53 vs 5,93±0,77, p<0.03). The intraventricular electromechanical delay was significantly improved with a mean decreased of 27,9 msec (52,6±11,4 mesc vs 24,7±6,5, p<0,001), while interventricular electromechanical delay was shortened of 72,2 msec (92,6±12,7 msec vs 20,4±7,6 msec, p<0,003).

Discussion

Our data shows that CRT in CHF seems improve autonomic function and reduce adrenergic tone as demonstrate by increasing HRV. In conclusion biventricular pacing can exert a positive effect on the mechanism that sustains the harmful hyper-adrenergic state and so it could be useful in opposition to disease progression.

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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