Document Detail

Ventricular endocardial right bifocal stimulation in the treatment of severe dilated cardiomyopathy heart failure with wide QRS.
MedLine Citation:
PMID:  11584459     Owner:  NLM     Status:  MEDLINE    
The QRS widening by ventricular conventional pacing impairs the systolic and diastolic functions and increases mitral regurgitation. The aim of this study was to compare conventional pacing to an alternative stimulation mode with a narrower QRS using two leads in the RV. Thirty-nine (25 men, 14 women; mean age 60.1 +/- 15.1 years) dilated cardiomyopathy patients (Chagas' disease [n = 17], coronariopathy [n = 9], AV ablation for tachycardiomyopathy [n = 3], and other [n = 10]) with cardiac failure (NYHA 3.1 +/- 0.8), pacemaker indication, and chronic AV block (22 AF) had endocardial pacemaker implantations (27 Biotronik, 12 Guidant). Two RV leads (one septal, one conventional [RV apex] were connected, respectively, to the atrial and ventricular pacemaker plugs. After clinical stabilization they were studied under three stimulation modes in the same session: AAI (septal), VVI (conventional), and ventricular endocardial right bifocal stimulation (VERBS) (DDT/DVI/DDD = AV interval = 15/10 ms). In comparison to conventional pacing, VERBS increased ejection fraction (0.124), cardiac output (19.5%), and peak filling rate (31.0%), and decreased QRS duration (24.7%), left atrium area (11.9%), mitral regurgitation area (32.3%), the diastolic transmitral flow (E/A relation) (19.3%), and the propagation flow time (18.0%) from the mitral valve to the left ventricular apex (tE_col), (P < 0.05). The quality-of-life showed an impressive score reduction of 50.4%. The septal stimulation alone showed a less expressive benefit. In severe dilated cardiomyopathy with classic pacemaker indication, VERBS showed significantly better performance than the septal or the conventional stimulation alone. There was a good systolic and a remarkable diastolic improvement causing an important reduction in the quality-of-life score.
J C Pachón; E I Pachón; R N Albornoz; J C Pachón; D S Kormann; V M Gimenes; P T Medeiros; M A Silva; J E Sousa; P P Paulista; L C Souza; A D Jatene
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  24     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-10-04     Completed Date:  2002-02-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1369-76     Citation Subset:  IM    
Departments of Pacemaker, Cardiovascular Surgery, and Cardiomyopathy, São Paulo Dante Pazzanese Cardiology Institute, University of São Paulo, Brazil.
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MeSH Terms
Aged, 80 and over
Cardiomyopathy, Dilated / physiopathology,  therapy*
Electrodes, Implanted*
Endocardium / physiopathology*
Follow-Up Studies
Heart Atria / physiopathology
Heart Failure / physiopathology,  therapy*
Heart Ventricles / physiopathology
Middle Aged
Mitral Valve Insufficiency / physiopathology,  therapy
Pacemaker, Artificial*
Quality of Life
Stroke Volume / physiology
Comment In:
Pacing Clin Electrophysiol. 2005 May;28(5):357-60   [PMID:  15869664 ]

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

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