Document Detail


Multisite stimulation in refractory heart failure.
MedLine Citation:
PMID:  10327326     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Since the early nineties, the employment of DDD pacing from a right ventricular site with a short AV delay in patients with severe heart failure has led to considerable conflicting results, so that the real benefit of this method remains to be defined even in selected patients, such as those with first-degree AV block, QRS duration > 140 ms due to left bundle branch block (LBBB), mitral regurgitation time > or = 450 ms and diastolic filling time < or = 200 ms. Indeed, the asynchronous activation induced by pacing the right apex is the most important limitation to the technique, particularly in patients without an LBBB pattern or in those with an incomplete LBBB pattern. Recent studies have also shown that pacing of the right interventricular septum provides no better results than pacing of the right apex, at least in selected patients with no LBBB pattern and no significant mitral regurgitation. Today, it has been suggested that permanent biventricular pacing could be proposed as a feasible and reliable approach to improving ventricular function through the synchronization of the septum and the apex of the left ventricle, particularly in patients with a marked delay in ventricular activation sequence. This technique may be performed by means of transvenous leads inserted through the coronary sinus into the cardiac veins to stimulate both ventricles simultaneously, starting from the right apex and left lateral wall. Consequently, this approach supplies a strong basis for initiating further studies to examine the chronic effects of left ventricular pacing in patients with severe heart failure. We also suggest that the new tissue Doppler imaging techniques could usefully be applied to accurately select candidates to biventricular pacing.
Authors:
G Ansalone; P Trambaiolo; G P Giorda; P Giannantoni; R Ricci; M Santini
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Giornale italiano di cardiologia     Volume:  29     ISSN:  0046-5968     ISO Abbreviation:  G Ital Cardiol     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-06-09     Completed Date:  1999-06-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1270331     Medline TA:  G Ital Cardiol     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  451-9     Citation Subset:  IM    
Affiliation:
Department of Heart Diseases, San Filippo Neri Hospital, Rome.
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MeSH Terms
Descriptor/Qualifier:
Cardiac Pacing, Artificial* / methods
Heart Failure / physiopathology,  therapy*
Heart Ventricles / physiopathology
Hemodynamics
Humans
Pacemaker, Artificial

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