Upgrading to resynchronization therapy after chronic right ventricular pacing improves left ventricular remodelling
Georg Fröhlich1, Jan Steffel, David Hürlimann
1Cardiovascular Center, Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland.
European Heart Journal
|March 18, 2010
Summary
Upgrading patients with chronic right ventricular pacing to cardiac resynchronization therapy (CRT) effectively reverses left ventricular remodeling. This approach benefits even those with long-term RV pacing, improving heart failure outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Chronic right ventricular (RV) pacing can cause ventricular dyssynchrony, leading to left ventricular (LV) remodeling, increased morbidity, and mortality.
- Cardiac resynchronization therapy (CRT) aims to restore synchronicity and prevent these adverse effects.
Purpose of the Study:
- To evaluate the effectiveness of upgrading patients with chronic RV pacing to CRT.
- To compare the effects of primary CRT implantation versus CRT upgrade on LV remodeling.
Main Methods:
- Analysis of 172 patients undergoing primary CRT (n=102) or CRT upgrade (n=70) from two tertiary centers.
- Mean follow-up of 21.7 and 23.5 months, respectively.
- Assessment of LV ejection fraction, LV end-diastolic diameter index, and LV end-systolic diameter.
Main Results:
- Both primary CRT and CRT upgrade groups showed significant improvements in LV ejection fraction, LV end-diastolic diameter index, and LV end-systolic diameter.
- Improvements did not differ significantly between primary CRT recipients and CRT upgrades.
- Response to CRT upgrade was independent of baseline characteristics, including duration of RV pacing (even >12 years in some patients).
Conclusions:
- CRT effectively reverses LV remodeling in heart failure patients with chronic RV pacing, similar to primary CRT recipients.
- These findings support the use of CRT in pacemaker-dependent heart failure patients, even after prolonged RV pacing.
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