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Published on: December 11, 2017
Cardiac pacing in patients with dilated cardiomyopathy
1Department of Medicine, Lovelace Medical Center, Albuquerque, New Mexico 87108, USA.
Insights
Cardiac pacing for dilated cardiomyopathy (DCM) shows mixed results, especially without traditional bradycardia. Further research is needed to clarify optimal pacing methods and measure benefits in specific patient groups.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Permanent cardiac pacing in dilated cardiomyopathy (DCM) has yielded contradictory findings.
- Novel pacing techniques like multisite and His bundle pacing show mixed preliminary results.
Purpose of the Study:
- To evaluate the current status and future directions of cardiac pacing in DCM patients.
- To identify patient subgroups who may benefit from pacing despite lacking traditional indications.
Main Methods:
- Review of existing studies on acute and chronic cardiac pacing effects in DCM.
- Analysis of preliminary data from novel pacing strategies.
- Discussion of potential methods for assessing pacing benefits.
Main Results:
- Pacing therapy for DCM without bradycardia indications is currently considered investigational.
- A subset of DCM patients with asynchronous contractions may benefit from pacing.
- Current evidence is inconclusive, necessitating further investigation.
Conclusions:
- Cardiac pacing may be beneficial for select DCM patients with specific timing abnormalities.
- Clarification of optimal pacing methods and benefit assessment is crucial.
- Further research is required to establish the role of pacing in DCM management.
Abstract:
Studies of both the acute and chronic effects of permanent cardiac pacing in patients with dilated cardiomyopathy have produced contradictory results. Similarly, theoretically promising novel pacing techniques such as multisite, His bundle, and right ventricular outflow tract pacing have also yielded mixed results in preliminary studies. In general, at the present time, pacing therapy should be considered investigational for patients with dilated cardiomyopathy who do not have traditional bradycardia indications; nevertheless, pacing therapy may be useful in a small population of patients with dilated cardiomyopathy who have inappropriate timing of left ventricular and left atrial contraction. The beneficial effects of cardiac pacing in some patients with DCM cannot be dismissed out of hand; they must be explained. What is needed is clarification of the best methods to measure any benefits of this therapy: among the options are echocardiographically determined parameters of forward flow and AV valve function, exercise test parameters such as duration and O2 consumption, global and regional ejection fraction, functional classification, quality of life questionnaires, neurohumoral parameters such as plasma atrial natriuretic peptide and catecholamines, and, finally, disease progression and survival.
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