Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Kass, D.A
Right arrow Search for Related Content
PubMed
Right arrow Articles by Kass, D.A
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Ventricular dyssynchrony and mechanisms of resynchronization therapy

D.A Kass*

Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.

* Correspondence: David A. Kass, Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MA 21287, U.S.A.

Abstract

Patients with dilated cardiomyopathy (DCM) that is further complicated by intra-ventricular conduction delay with discoordinate wall motion have increased mortality risk as compared with the general DCM population. Dyssynchrony reduces cardiac systolic function while increasing oxygen consumption, and may be a source of arrhythmia. The recent development of endocardial lead systems to activate the left ventricle prematurely has yielded the novel therapeutic option of resynchronization therapy to correct cardiac dyssynchrony. Using either biventricular or left ventricular pre-excitation, systolic function and energetic efficiency can be substantially enhanced in heart failure patients who have underlying discoordinate contraction. The present review addresses the pathophysiology of cardiac dyssynchrony and the mechanisms that underlie resynchronization treatment.

Key Words: Bi-entricular • heart failure • haemodynamic • pacemaker • pacing

References

  1. Xiao HB, Roy C, Fujimoto S, Gibson DG. Natural history of abnormal conduction and its relation to prognosis in patients with dilated cardiomyopathy. Int J Cardiol. 1996;53:163–170[CrossRef][Web of Science][Medline]
  2. Murkofsky RL, Dangas G, Diamond JA, Mehta D, Schaffer A, Ambrose JA. A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular dysfunction. J Am Coll Cardiol. 1998;32:476–482[Abstract/Free Full Text]
  3. Hamby RI, Weissman RH, Prakash MN, Hoffman I. Left bundle branch block: a predictor of poor left ventricular function in coronary artery disease. Am Heart J. 1983;106:471–477[CrossRef][Web of Science][Medline]
  4. Meisner JS, McQueen DM, Ishida Y, et al. Effects of timing of atrial systole on LV filling and mitral valve closure: computer and dog studies. Am J Physiol. 1985;249:H604–H619
  5. Yellin EL, Nikolic S, Frater RWM. Left ventricular filling dynamics and diastolic function. Prog Cardiovasc Dis. 1990;32:247–271[CrossRef][Web of Science][Medline]
  6. Brecker SJ, Xiao HB, Sparrow J, Gibson DG. Effects of dualchamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet. 1992;340:1308–1312[CrossRef][Web of Science][Medline]
  7. Linde C, Gadler F, Edner M, Nordlander R, Rosenqvist M, Ryden L. Results of atrioventricular synchronous pacing with optimized delay in patients with severe congestive heart failure. Am J Cardiol. 1995;75:919–923[CrossRef][Web of Science][Medline]
  8. Prinzen FW, Hunter WC, Wyman BT, McVeigh ER. Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging. J Am Coll Cardiol. 1999;33:1735–1742[Abstract/Free Full Text]
  9. Wyman BT, Hunter WC, Prinzen FW, McVeigh ER. Mapping propagation of mechanical activation in the paced heart with MRI tagging. Am J Physiol. 1999;276:H881–H891
  10. Wyman BT, Hunter WC, Prinzen FW, Faris OP, McVeigh ER. Effects of single- and biventricular pacing on temporal and spatial dynamics of ventricular contraction. Am J Physiol Heart Cite Physiol. 2002;282:H372–H379
  11. Curry CW, Nelson GS, Wyman BT, et al. Mechanical dyssynchrony in dilated cardiomyopathy with intraventricular conduction delay as depicted by 3D tagged magnetic resonance imaging. Circulation. 2000;101:E2
  12. Nelson GS, Curry CW, Wyman BT, et al. Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay. Circulation. 2000;101:2703–2709[Abstract/Free Full Text]
  13. Burkhoff D, Oikawa RY, Sagawa K. Influence of pacing site on canine left ventricular contraction. Am J Physiol. 1986;251:H428–H435
  14. Park RC, Little WC, O'Rourke RA. Effect of alteration of the left ventricular activation sequence on the left ventricular end-systolic pressure-volume relation in closed-chest dogs. Circ Res. 1985;57:706–717[Abstract/Free Full Text]
  15. Heyndrickx GR, Vantrimpont PJ, Rousseau MF, Pouleur H. Effects of asynchrony on myocardial relaxation at rest and during exercise in conscious dogs. Am J Physiol. 1988;254:H817–H822
  16. Leclercq C, Cazeau S, Le Breton H, et al. Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J Am Coll Cardiol. 1998;32:1825–1831[Abstract/Free Full Text]
  17. Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002;39:194–201[Abstract/Free Full Text]
  18. Auricchio A, Stellbrink C, Block M, et al. Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group. Circulation. 1999;99:2993–3001[Abstract/Free Full Text]
  19. Kass DA, Chen CH, Curry C, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999;99:1567–1573[Abstract/Free Full Text]
  20. Fetics BJ, Wong EY, Murabayashi T, et al. Enhancement of contrast echocardiography by image variability analysis. IEEE Trans Med Imaging. 2001;20:1123–1130[CrossRef][Web of Science][Medline]
  21. Garrigue S, Jais P, Espil G, et al. Comparison of chronic biventricular pacing between epicardial and endocardial left ventricular stimulation using Doppler tissue imaging in patients with heart failure. Am J Cardiol. 2001;88:858–862[CrossRef][Web of Science][Medline]
  22. Sogaard P, Kim WY, Jensen HK, et al. Impact of acute biventricular pacing on left ventricular performance and volumes in patients with severe heart failure. A tissue doppler and three-dimensional echocardiographic study. Cardiology. 2001;95:173–182[CrossRef][Web of Science][Medline]
  23. Blanc JJ, Etienne Y, Gilard M, et al. Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. Circulation. 1997;96:3273–3277[Abstract/Free Full Text]
  24. Hamdan MH, Zagrodzky JD, Joglar JA, et al. Biventricular pacing decreases sympathetic activity compared with right ventricular pacing in patients with depressed ejection fraction. Circulation. 2000;102:1027–1032[Abstract/Free Full Text]
  25. Butter C, Auricchio A, Stellbrink C, et al. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation. 2001;104:3026–3029[Abstract/Free Full Text]
  26. Baller D, Wolpers HG, Zipfel J, Bretschneider HJ, Hellige G. Comparison of the effects of right atrial, right ventricular apex and atrioventricular sequential pacing on myocardial oxygen con sumption and cardiac efficiency: a laboratory investigation. Pacing Clin Electrophysiol. 1988;11:394–403[CrossRef][Medline]
  27. Owen CH, Esposito DJ, Davis JW, Glower DD. The effects of ventricular pacing on left ventricular geometry, function, myocardial oxygen consumption, and efficiency of contraction in conscious dogs. Pacing Clin Electrophysiol. 1998;21:1417–1429[CrossRef][Medline]
  28. Nelson GS, Berger RD, Fetics BJ, Talbot M, Hare JM, Spinelli JCKDA. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated car diomyopathy and left bundle-branch block. Circulation. 2000;102:3053–3059[Abstract/Free Full Text]
  29. Cappola TP, Kass DA, Nelson GS, et al. Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy. Circulation. 2001;104:2407–2411[Abstract/Free Full Text]
  30. Ingwall JS. Is cardiac failure a consequence of decreased energy reserve? Circulation. 1993;87(suppl VII):VII–58-VII-62
  31. Cazeau S, Leclercq C, Lavergne T, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001;344:873–880[Abstract/Free Full Text]
  32. Abraham WT. Late breaking clinical trials: results from late breaking clinical trial sessions at ACC 2001. J Am Coll Cardiol. 2001;38:604–605
  33. Zardini M, Tritto M, Bargiggia G, et al. The InSynch Italian registry: analysis of clinical outcome and considerations on the selection of candidates to left ventricular resynchronization. Eur Heart J. 2000;2:J16–J22
  34. Bristow MR, Feldman AM, Saxon LA. Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION) trial. COMPANION Steering Committee and COMPANION Clinical Investigators. J Card Fail. 2000;6:276–285[CrossRef][Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur Heart JHome page
I. Garcia-Bolao, B. Lopez, A. Macias, J. J. Gavira, P. Azcarate, and J. Diez
Impact of collagen type I turnover on the long-term response to cardiac resynchronization therapy
Eur. Heart J., April 1, 2008; 29(7): 898 - 906.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Physiol. Heart Circ. Physiol.Home page
J. J. M. Zwanenburg, M. J. W. Gotte, J. P. A. Kuijer, M. B. M. Hofman, P. Knaapen, R. M. Heethaar, A. C. van Rossum, and J. T. Marcus
Regional timing of myocardial shortening is related to prestretch from atrial contraction: assessment by high temporal resolution MRI tagging in humans
Am J Physiol Heart Circ Physiol, February 1, 2005; 288(2): H787 - H794.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. Achilli, M. Sassara, S. Ficili, D. Pontillo, P. Achilli, C. Alessi, S. De Spirito, R. Guerra, N. Patruno, and F. Serra
Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and "narrow" QRS
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2117 - 2124.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Kass, D.A
Right arrow Search for Related Content
PubMed
Right arrow Articles by Kass, D.A
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?