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Acute haemodynamic effects of AV-synchronous pacemaker stimulation in patients with congestive heart failure and left
M Kowalsky1, R Grove, W Kranig
1Department of Cardiology, Schüchtermann-Klinik, Ulmenallee 11, 49214 Bad Rothenfelde, Germany.
Insights
Pacemaker stimulation improved cardiac output and reduced pulmonary capillary pressure in most patients with severe heart failure and left bundle branch block. This therapy offers a potential adjunctive treatment option for selected individuals.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Severe chronic heart failure necessitates novel therapeutic strategies beyond conventional drug and surgical interventions.
- Previous research indicated positive effects of AV-synchronous pacing in dilated cardiomyopathy with first-degree AV-block.
- This study investigates the efficacy of transient pacemaker stimulation in patients with dilated cardiomyopathy and left bundle branch block (LBBB).
Purpose of the Study:
- To evaluate the therapeutic benefit of transient pacemaker stimulation in patients diagnosed with dilated cardiomyopathy and LBBB.
- To assess the impact of AV-sequential pacing on hemodynamic parameters in this patient cohort.
Main Methods:
- Nineteen patients with NYHA class III or greater congestive heart failure and LBBB were enrolled.
- Transient myocardial stimulation was delivered using VDD mode with varying AV-delay times (80-180 ms).
- Cardiac output, pulmonary capillary pressure, and pulmonary arterial pressure were measured using thermodilution.
Main Results:
- Pacemaker stimulation significantly increased cardiac output (p < 0.002), cardiac index (p < 0.002), and stroke volume (p < 0.002) in 16 out of 19 patients.
- Mean pulmonary capillary pressure significantly decreased (p < 0.01), while mean pulmonary arterial pressure remained unchanged.
- Three patients did not demonstrate a beneficial response to the pacing intervention.
Conclusions:
- AV-sequential pacemaker stimulation, with right ventricular electrode placement, shows promise as an adjunctive therapy.
- This approach may be valuable for selected patients suffering from late-stage congestive heart failure and LBBB.
- Further research could explore optimal pacing strategies for this patient group.
Introduction:
The therapeutical limits of drug and surgical therapy for severe chronic heart failure make the research for adjunctive treatment options necessary. After the positive effects of AV-synchronous pacemaker stimulation in patients with dilatative cardiomyopathy and 1st degree AV-block, this study was to evaluate the benefit of transient pacemaker stimulation in patients with dilated cardiomyopathy and left bundle branch block.
Methods And Patients:
19 patients (14 male, 5 female, age 60 +/- 8 yrs) were included in the study. Inclusion criteria were congestive heart failure, stage NYHA III or greater and left bundle branch block. Transient stimulation of the myocardium was applied via two electrodes (right atrium and right ventricle) in VDD mode, whereby a series of AV-delay-times between 80 and 180 ms was tested. Thermodilution was used to determine cardiac output, pulmonary capillary pressure and pulmonary arterial pressure.
Results:
In 16 patients, pacemaker stimulation led to a significant increase of cardiac output (3.8 +/- 0.5 l/min to 4.6 +/- 0.5 l/min; p < 0.002), cardiac index (1.90 +/- 0.20 l/min/m2 to 2.3 +/- 0.2 l/min/m2; p < 0.002) and of stroke volume (51 +/- 8 ml to 62 +/- 6 ml; p < 0.002) as well as a significant reduction of mean pulmonary capillary pressure (19 +/- 1 mmHg to 15 +/- 1 mmHg; p < 0.01). The mean pulmonary arterial pressure remained unchanged. Three patients did not benefit from the treatment.
Conclusion:
AV-sequential pacemaker-stimulation (right ventricular electrode placement) can be a valuable adjunctive therapy in selected patients with late stage congestive heart failure and left bundle branch block.