| Bifocal pacing - A novel cardiac resynchronization therapy? Results of bifocal pacing study and review of the current literature. | |
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MedLine Citation:
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PMID: 17426798 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Bifocal pacing (BFP) has been proposed as a more feasible alternative of cardiac resynchronization therapy (CRT). AIM: To evaluate BFP in patients with severe congestive heart failure and significant intraventricular conduction delay and to compare it with biventricular pacing (BVP). METHODS: Both echocardiographic examination including tissue Doppler imaging and invasive measurements of cardiac hemodynamics was performed under basal conditions and during BFP and BVP. RESULTS: 50 patients were included: 29 patients with ischemic heart disease (IHD), 21 patients with idiopathic dilated cardiomyopathy (IDCM). Left ventricular (LV) pressure gradient (dp/dt max) increased during BFP compared to the baseline (13.4 %, 95 % CI 9.2-17.6 %, p < 0.0001) and a further increase was achieved during BVP (29.5 %, 95 % CI 23.7-35.4 %, p < 0.0001). A significant correlation was found between the distance of the right ventricular apical and outflow tract leads and percentage of dp/dt max increase in IDCM patients (r = 0.72, p < 0.001), but not in IHD patients. Interventricular mechanical delay (IVMD) decreased in BFP compared to baseline (43 +/- 22 ms vs. 53 +/- 31 ms, p = 0.006). BVP produced even shorter IVMD (22 +/- 19 ms, p < 0.0001). In all patients, the regional systolic contraction times were significantly shortened, corresponding with prolongation of the respective regional diastolic filling times during both BFP (p < 0.05 for all segments) and BVP (p < 0.001 for all segments). The effect of BVP on regional systole shortening was more pronounced. CONCLUSIONS: BFP improves LV hemodynamics by decreasing the inter- and intraventricular conduction delays. The leads in the right ventricle should be placed at the longest achievable distance. BVP is superior to BFP. |
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Authors:
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Alan Bulava; Jan Lukl |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Biomedical papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia Volume: 150 ISSN: 1213-8118 ISO Abbreviation: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Publication Date: 2006 Nov |
Date Detail:
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Created Date: 2007-04-11 Completed Date: 2008-03-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101140142 Medline TA: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Country: Czech Republic |
Other Details:
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Languages: eng Pagination: 303-12 Citation Subset: IM |
Affiliation:
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1st Department of Internal Medicine, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic. alanbulava@seznam.cz |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Arrhythmias, Cardiac / etiology, therapy Cardiac Pacing, Artificial* / methods Electrocardiography Female Heart Failure / complications Hemodynamics Humans Male Middle Aged Ventricular Function, Left |
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