Related Experiment Videos
Value of pacing in cardiac failure associated with chronic atrioventricular block
Insights
Permanent pacing offers limited symptomatic benefit for chronic complete atrioventricular block with cardiac failure. However, pacing may prolong survival, especially in patients without syncope, though prognosis remains poor with coronary artery disease.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Chronic complete atrioventricular block (CAVB) often presents with cardiac failure, posing significant management challenges.
- Permanent pacing is a common intervention for symptomatic bradycardia, but its efficacy in CAVB with concurrent cardiac failure is less defined.
Purpose of the Study:
- To evaluate the long-term effects of permanent pacemaker implantation on patients with CAVB and cardiac failure.
- To assess hemodynamic and clinical outcomes, as well as survival rates, following pacing in this patient cohort.
Main Methods:
- A prospective study of 6 patients with CAVB and cardiac failure, measuring indirect left atrial pressure pre- and post-pacing.
- A retrospective review of 21 patients with CAVB and cardiac failure, assessed clinically 3-6 years after pacemaker implantation.
Main Results:
- Hemodynamic improvement was observed in only 1 of 6 patients in the prospective arm; 1 patient died from cardiac failure.
- In the retrospective group, 10 of 21 patients showed clinical improvement, while 8 died over a mean follow-up of 53 months.
- Pacing provided minimal symptomatic benefit in the absence of syncope but was associated with improved survival in some cases.
Conclusions:
- Permanent pacing in CAVB with cardiac failure yields modest hemodynamic and symptomatic benefits, with a significant mortality rate.
- Coronary artery disease portends a particularly poor prognosis in these patients.
- Predicting individual prognosis before pacing remains challenging.
Abstract:
The effect of permanent pacing on chronic complete atrioventricular block complicated by cardiac failure was studied in 6 patients by measurement of indirect left atrial pressure 15 minutes after institution of pacing and again 3 to 12 months later. In addition, 21 patients with complete heart block and clinical plus radiological evidence of cardiac failure at the time of pacing 3 to 6 years earlier were also reviewed. Only 1 of 6 patients studied haemodynamically improved and 1 died in cardiac failure. Of 21 patients assessed clinically, 10 had improved and 8 had died after a mean follow-up of 53 months. In the absence of syncope, pacing was of little symptomatic benefit but still may be justified to prolong survival. Both studies indicated a particularly poor prognosis for patients known to have coronary artery disease. No reliable means were found of determining the prognosis in the individual patient with cardiac failure before pacing.