| Biventricular pacing in chronic heart failure acutely facilitates the arterial baroreflex. | |
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MedLine Citation:
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PMID: 18552164 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Metabolic and mechanical stress in the failing heart activates the cardiac sympathetic afferent reflex (CSAR). It has been demonstrated that cardiac resynchronization therapy (CRT) acutely reduces MSNA in clinical responders. Mechanistically, this beneficial effect might be explained by acute deactivation of the CSAR. In addition to sympathoexcitation, CSAR inhibits the arterial baroreflex at the level of the nucleus tractus solitarii. Hence, in responders, CRT is likely to remove/reduce this inhibition. Therefore, we hypothesized that CRT acutely facilitates the arterial baroreflex. One day after implantation of a CRT device in 32 patients with chronic heart failure (LVEF; 27 +/- 6%), we measured noninvasive baroreflex sensitivity (BRS) and heart rate variability (HRV) in two conditions: CRT device switched on and switched off (on/off order randomized). BRS changes were correlated with the difference in unpaced/paced LVEF, a measure of acute mechanical response to CRT. CRT increased BRS by 35% from 2.96 to 3.79 ms/mmHg (P < 0.02) and increased HRV (standard deviation of the intervals between normal beats) from 18.5 to 24.0 ms (P < 0.01). The CRT-induced relative change in BRS correlated with the change in LVEF (r = 0.44; P < 0.01). In conclusion, CRT acutely increases BRS and HRV. This favorable response of the autonomic nervous system might be caused by CRT-induced CSAR deactivation. Follow-up studies should verify the mechanism of the acute response and the possible predictive value of an acute positive BRS response. |
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Authors:
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Maaike G J Gademan; Rutger J van Bommel; Claudia Ypenburg; Joris C W Haest; Martin J Schalij; Ernst E van der Wall; Jeroen J Bax; Cees A Swenne |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2008-06-13 |
Journal Detail:
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Title: American journal of physiology. Heart and circulatory physiology Volume: 295 ISSN: 0363-6135 ISO Abbreviation: Am. J. Physiol. Heart Circ. Physiol. Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-08-08 Completed Date: 2008-09-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100901228 Medline TA: Am J Physiol Heart Circ Physiol Country: United States |
Other Details:
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Languages: eng Pagination: H755-60 Citation Subset: IM |
Affiliation:
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Dept. of Cardiology, Leiden Univ. Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Baroreflex* Blood Pressure Cardiac Pacing, Artificial / methods* Chronic Disease Female Heart Failure / etiology, physiopathology, therapy* Heart Rate Humans Male Middle Aged Myocardial Ischemia / complications*, physiopathology, therapy Stroke Volume Sympathetic Nervous System / physiopathology* Treatment Outcome Ventricular Function, Left |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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