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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Acute and chronic effects of cardiac resynchronization in patients developing heart failure with long-term pacemaker

Masayuki Shimano1, Yukiomi Tsuji, Yukihiko Yoshida

  • 1Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

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
|June 15, 2007
PubMed

Insights

Cardiac re-synchronization therapy (CRT) improves heart failure in patients with acquired complete atrioventricular block (CAVB) and right ventricular apical (RVA)-pacing. Early CRT upgrade is recommended to mitigate irreversible left ventricular remodeling.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Right ventricular apical (RVA)-pacing for acquired complete atrioventricular block (CAVB) can lead to heart failure (HF).
  • Left ventricular (LV) dysfunction and remodeling are potential complications of long-term RVA-pacing.
  • The efficacy of cardiac re-synchronization therapy (CRT) in this specific patient population requires further investigation.

Purpose of the Study:

  • To evaluate the effects of CRT in CAVB patients who developed HF during RVA-pacing.
  • To assess the impact of CRT on cardiac function, symptoms, and LV remodeling.
  • To determine the optimal timing for CRT upgrade in this patient group.

Main Methods:

  • Retrospective analysis of 18 consecutive CAVB patients with HF during RVA-pacing.
  • Hemodynamic assessments immediately and 12 months after CRT upgrade.
  • Evaluation of LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDd), New York Heart Association (NYHA) classification, and hospitalization rates.

Main Results:

  • RVA-pacing duration correlated with LVEF deterioration.
  • Biventricular (BiV)- and LV-pacing acutely improved systolic function; only BiV improved diastolic function.
  • One-year post-CRT: NYHA class improved by 35%, hospitalizations decreased by 85%, LVEDd decreased by 7%, and LVEF increased by 23%.
  • CRT-induced LVEDd reduction was greater in patients with < 5 years of RVA-pacing.

Conclusions:

  • CRT upgrade significantly improves cardiac function and symptoms in CAVB patients with pacing-induced HF.
  • Adverse LV remodeling may be partially irreversible, suggesting early CRT consideration.
  • Prospective studies on the optimal timing of CRT upgrade are warranted.
Abstract

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