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

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
Polychronis DilaverisChristodoulos Stefanadis

Abstract

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 in...Continue Reading

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Citations

Feb 28, 2013·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·Andrea MazzaGiampiero Giordano
Sep 9, 2008·Progress in Cardiovascular Diseases·Chung-Wah SiuHung-Fat Tse
Feb 22, 2011·Journal of Cardiovascular Electrophysiology·Evan AdelsteinSamir Saba
Jun 22, 2010·Journal of Cardiovascular Electrophysiology·Spyridon DeftereosChristodoulos Stefanadis
Sep 17, 2014·Pacing and Clinical Electrophysiology : PACE·Satoshi YanagisawaToyoaki Murohara
Oct 19, 2006·Journal of the American College of Cardiology·Hung-Fat Tse, Chu-Pak Lau
May 15, 2018·Pacing and Clinical Electrophysiology : PACE·Cory R TrankleGautham Kalahasty
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Jan 17, 2007·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·Houman AshrafianAndrew G Mitchell
Jan 26, 2018·Journal of Cardiovascular Development and Disease·Daniele MasaroneGiuseppe Pacileo

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