Jun 30, 2011

Extrasystolic stimulation with bi-ventricular pacing: an acute haemodynamic evaluation

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
Berthold StegemannTamas Szili-Török

Abstract

Cardiac resynchronization therapy (CRT) by means of biventricular pacing (BiVP) is well established as a treatment for patients with heart failure (HF). Post-extrasystolic potentiation, (PESP) which involves a transient increase in myocardial contractility following a ventricular extrasystole, can be achieved using extrasystolic stimulation (ESS). On this basis, ESS has been proposed as a therapeutic. We assessed acute haemodynamic effects of ESS in the context of BiVP. Patients (n = 15, left ventricular ejection fraction < 40%, QRS ≥ 125 ms) with HF, received BiVP in combination with right ventricular (RV) ESS (single stimulus or pulse train). Left ventricular (LV) and peripheral arterial pressures were recorded and dP/dt was monitored. Addition of RV ESS to BiVP pacing led to a 21% increase in maximum (max) dP/dt (P < 0.001) and an 8.5 mm Hg increase in a systolic arterial pressure (P < 0.001). The modest fall in end-diastolic pressure (3.3 mmHg, P < 0.001) observed during ESS and BiVP was prevented by maintaining baseline sinus rate. Varying ESS modes or pacing outputs was not associated with differences in haemodynamic parameters. Biventricular pacing in combination with ESS, with maintenance of sinus rate, improves myocard...Continue Reading

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Mentioned in this Paper

Sinoatrial Node
Arterial Pulse Pressure
Myocardial Contraction
Diastolic Blood Pressure
Myocardium
Sinus - General Anatomical Term
Left Ventricular Function
Systole
Cardiomyopathies
Heart Ventricle

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