Journal Article

Acute and chronic effects of cardiac resynchronization in patients developing heart failure with long-term pacemaker therapy for acquired complete atrioventricular block

Masayuki Shimano, Yukiomi Tsuji, Yukihiko Yoshida, Yasuya Inden, Naoya Tsuboi, Teruo Itoh, Hirohiko Suzuki, Takashi Muramatsu, Taro Okada, Shuji Harata, Takumi Yamada, Haruo Hirayama, Stanley Nattel and Toyoaki Murohara

in EP Europace

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

Volume 9, issue 10, pages 869-874
Published in print October 2007 | ISSN: 1099-5129
Published online June 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum119
Acute and chronic effects of cardiac resynchronization in patients developing heart failure with long-term pacemaker therapy for acquired complete atrioventricular block

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Aims We assessed the effects of cardiac re-synchronization therapy (CRT) in patients who developed otherwise unexplained heart failure (HF) during right ventricular apical (RVA)-pacing for acquired complete atrioventricular block (CAVB).

Methods and results Eighteen consecutive CAVB patients with HF during RVA-pacing were assessed with haemodynamic studies immediately and 12 months after CRT-upgrade. Ten patients had idiopathic CAVB and 13 showed normal left ventricular (LV) function at RVA-pacemaker implantation. HF developed after 81 ± 10 months. RVA-pacing duration correlated (r = 0.49, P < 0.05) with LV ejection fraction (LVEF) deterioration. Biventricular- (BiV) and LV-pacing acutely improved the systolic function comparably, but only BiV improved diastolic function. One-year post-CRT-initiation, New York Heart Association classification improved 35 ± 3% (P < 0.05) and the number of hospitalizations decreased 85 ± 3% (P < 0.0001). CRT decreased LV end-diastolic diameter (LVEDd) 7 ± 2% (P < 0.01) and increased LVEF by 23 ± 7% (P < 0.01). The CRT-induced reduction in LVEDd tended to be greater in patients with RVA-pacing for < 5 years vs. > 5 years (7.7 ± 2.5 vs. 3.6 ± 1.0 mm, P = 0.08).

Conclusion CRT-upgrade improves the cardiac function and symptoms in CAVB patients with HF progression related to RVA-pacing. Because adverse LV-remodelling may be partly irreversible, consideration should be given to BiV- and LV-pacing upgrade as soon as possible after the indications appear, and prospective studies of the optimal timing of CRT-upgrade may be useful.

Keywords: Pacing; Heart failure; Resynchronization; Complete AV block

Journal Article.  3540 words.  Illustrated.

Subjects: Cardiovascular Medicine

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