Journal Article

Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick?

Polychronis Dilaveris, Antonios Pantazis, Georgios Giannopoulos, Andreas Synetos, John Gialafos and Christodoulos Stefanadis

in EP Europace

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

Volume 8, issue 5, pages 352-357
Published in print May 2006 | ISSN: 1099-5129
Published online May 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eul015
Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick?

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Dyssynchrony imposed on ventricular function by right ventricular (RV) apical pacing may lead in some cases to worsening or appearance of heart failure (HF) symptoms. This is a result of an altered pattern of activation, leading to several histological and functional adjustments of the left ventricle, including inhomogeneous thickening of the ventricular myocardium and myofibrillar disarray, fibrosis, disturbances in ion-handling protein expression, myocardial perfusion defects, alterations in sympathetic tone and mitral regurgitation. Studies of mid- and long-term effects of RV apical pacing on left ventricular (LV) function have demonstrated a progressive decline in ejection fraction and other indices of LV functional competence. Upgrading RV pacing systems to biventricular resynchronization modalities is a theoretically promising option for paced patients with worsening HF. The potentially favourable effect of upgrading on LV functional indices and patient clinical status has been demonstrated in few, non-randomized trials. Apart from the scantiness of existing clinical data, issues concerning technical aspects of the procedure and selection of eligible patients are raised. Is pacing-induced dyssynchrony equivalent to the indigenous dyssynchrony in unpaced patients with HF? What selection criteria should be applied in order to identify potential responders to cardiac resynchronization therapy in this patient population? Answers to these and more questions are still lacking.

Keywords: Dyssynchrony; Biventricular pacing; Heart failure; Upgrade; Pacemakers

Journal Article.  3693 words.  Illustrated.

Subjects: Cardiovascular Medicine

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