Document Detail


LV based pacing in patients with heart failure and a narrow QRS--an acute hemodynamic study.
MedLine Citation:
PMID:  19124935     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Biventricular pacing is beneficial in refractory systolic heart failure having QRS duration more than 130 msec by improving regional dysynchrony and decreasing diastolic mitral regurgitation. Current data show significant systolic dysynchrony in symptomatic systolic heart failure patients out of which nearly 40% have a QRS duration of less than 120 msec. Our study aims at assessing acute hemo-dynamic impact of Biventricular (BiV) and compare it with isolated left ventricular (LV) pacing in patients of systolic heart failure and QRS duration < or = 120 msec. METHODS: Seven patients with symptomatic systolic heart failure with LV Ejection fraction (LVEF) < or = 35% (mean 25.7 +/- 11.3%). NYHA functional class more than II and QRS duration < or = 120 msec (mean 92.8 +/- 17.0 msec) were studied at baseline and following BiV and LV pacing with AV delay 100 msec for 5 minutes in random order. Parameters analyzed were heart rate, systolic BP, pulse pressure, LV dimension, LVEF, cardiac output(CO), LV dP/dT, LV and RV isovolumic contraction time and aorto pulmonary flow delay. Duration of QRS complex at baseline and following pacing was noted. 'Responders' were defined as having increase in CO by at least 10% of mean basal cardiac output in study group. RESULTS: BiV pacing resulted in significant improvement in systolic BP (140.71 +/- 21.33 vs 149.29 +/- 19.67 mmHg, p = 0.02), pulse pressure (58.14 +/- 21.14 vs 67.29 +/- 19.57 mmHg, p = 0.01), LVEF (25.71 +/- 11.3 vs 32.86 +/- 4.60%, p = 0.01), CO (3.24 +/- 1.05 vs 3.89 +/- 1.1 l/min, p = 0.02) and LV dP/dT (0.69 +/- 0.22 vs 1.00 +/- 0.23 mmHg/msec, p = 0.001) with a trend towards reduction in LV isovolumic contraction time (115.28 +/- 21.61 vs 99.29 +/- 17.18 msec, p = 0.14) and aorto pulmonary flow delay (25.14 +/- 24.36 vs 12.14 +/- 36.15 msec, p = 0.32). LV pacing resulted in a trend towards improvement in parameters as compared to baseline, systolic BP (140.71 +/- 21.33 vs 146.71 +/- 23.03 mmHg, p = 0.16); pulse pressure (58.14 +/- 21.14 vs 63.29 +/- 26.59 mmHg, p = 0.2); LVEF (25.71 +/- 11.3 vs 33.27 +/- 10.0, p = 0.06); CO (3.24 +/- 1.05 vs 3.27 +/- 0.6 l/min, p = 0.88); LV dP/dT (0.69 +/- 0.22 vs 0.96 +/- 0.39 mmHg/msec, p = 0.16); LV isovolumic contraction time (115.28 +/- 21.61 vs 98.21 +/- 21.34 msec, p = 0.18); aortopulmonary flow delay (25.14 +/- 24.36 vs 5.21 +/- 30.1 msec, p = 0.2). Biventricular and LV pacing resulted in a non-significant increase in duration of paced QRS complexes (105.43 +/- 14.82 msec, p = 0.11 and 108.86 +/- 19.73, p = 0.15 respectively) as compared to 92.86 +/- 17.04 msec at baseline. Three out of 7 patients could be classified as 'responders' to biventricular pacing. CONCLUSION: BiV pacing, and not LV pacing, benefits patients of systolic heart failure (EF < or = 35%) and narrow QRS (< or = 120 msec) on surface ECG.
Authors:
Sk Dwivedi; Chirag Sheth; Aniket Puri; Vs Narain; Rk Saran; Vk Puri
Related Documents :
18196655 - Unfavourable effects of continuous, atrial-synchronised ventricular pacing on ventricul...
18772065 - Cardiac markers of pre-clinical disease in adolescents with the metabolic syndrome: the...
156605 - The influence of left ventricular late diastolic filling on the a wave of the left vent...
2978465 - A simple technique for producing supravalvular aortic stenosis in animals.
18385005 - Inferior vena cava diameter correlates with invasive hemodynamic measures in mechanical...
1383835 - Cp-96,345, a non-peptide antagonist of substance p: ii. actions on substance p-induced ...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Indian heart journal     Volume:  59     ISSN:  0019-4832     ISO Abbreviation:  Indian Heart J     Publication Date:    2007 May-Jun
Date Detail:
Created Date:  2009-01-06     Completed Date:  2009-03-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374675     Medline TA:  Indian Heart J     Country:  India    
Other Details:
Languages:  eng     Pagination:  250-5     Citation Subset:  IM    
Affiliation:
Department of Cardiology, King George's Medical University, Lucknow, India. skdwivedi_dr@rediffmail.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Blood Pressure / physiology
Cardiac Pacing, Artificial*
Electrocardiography
Female
Heart Failure, Systolic / physiopathology,  therapy*
Humans
Male
Middle Aged
Ventricular Dysfunction, Left / physiopathology
Comments/Corrections
Comment In:
Indian Heart J. 2007 May-Jun;59(3):207-10   [PMID:  19124926 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Prevention of no flow/slow reflow phenomenon in primary PCI by Nicorandil.
Next Document:  A study of ventricular asynchrony in patients with varying QRS duration and its correlation with lef...