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 Auricchio, A
Right arrow Articles by Klein, H.U
Right arrow Search for Related Content
PubMed
Right arrow Articles by Auricchio, A
Right arrow Articles by Klein, H.U
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Beyond expectations: a decade of positive results with cardiac resynchronization therapy for heart failure

A Auricchio* and H.U Klein

Division of Cardiology, University Hospital, Otto-von-Guericke Universität, Magdeburg, Germany

* Correspondence: Angelo Aurichiom, MD, PhD, Department of Cardiology, University Hospital, Leipzigertr. 44D, 39120 Magdeburg, Germany.

Abstract

Ventricular dysfunction and ventricular dilatation (a hallmark of heart failure) may cause atrial and ventricular conduction delays. Pharmacological treatment is unable to correct such conduction delays and their associated detrimental mechanical effects. In contrast, cardiac resynchronization therapy (CRT) has successfully been used in patients with heart failure to correct electrical activation abnormalities, resulting in major improvements in haemodynamic and cardiac pumping efficiency. Data collected by independent investigators during acute testing consistently show that CRT increases stroke volume, improves ventricular contractility, and reduces diastolic and systolic mitral insufficiency. In patients with heart failure chronically paced with re synchronization devices, small randomized trials have consistently reported short-term and mid-term improvements in functional class, exercise capacity and quality of life. Significant symptomatic benefits have also been confirmed in a large European registry, including over 1000 patients followed for 6 months after implantation of a CRT device. Furthermore, a resetting of the neurohumoral status has been documented in patients receiving CRT. Two completed studies have reported fewer hospitalizations with CRT than with pharmacological therapy. Trials examining the effects of CRT on long-term morbidity and mortality are in progress.

Key Words: Cardiomyopathies • heart failure • pacing • resynchronization therapy

References

  1. Aaronson KD, Schwartz S, Chen T-M, Wong K-L, Goin JE, Mancini DM. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation. 1997;95:2660–2667[Abstract/Free Full Text]
  2. Fried AG, Parker AB, Newton GE, Parker JD. Electrical and hemodynamic correlates of the maximal rate of pressure increase in the human left ventricle. J Card Fail. 1999;5:8–16[Web of Science][Medline]
  3. Xiao HB, Roy C, Gibson DG. Nature of ventricular activation in patients with dilated cardiomyopathy: evidence for bilateral bundle branch block. Br Heart J. 1994;72:167–174[Abstract/Free Full Text]
  4. Grines CL, Bashore TM, Boudoulas Olson S, Shafer P, Wooley CF. Functional abnormalities in isolated left bunble branch block. The effect of interventricular asynchrony. Circulation. 1989;79:845–853[Abstract/Free Full Text]
  5. Herman MV, Heinle RA, Klein MD, Gorlin R. Localized disorders in myocardial contraction. Asynergy and its role in congestive heart failure. N Engl J Med. 1967;277:222–232
  6. Xiao HB, Roy C, Gibson DG. Nature of ventricular activation in patients with dilated cardiomyopathy: evidence for bilateral bundle branch block. Br Heart J. 1994;72:167–174
  7. Lattuca JJ, Cohen TJ, Mower MM. Vi-ventricular pacing to improve cardiac hemodynamics. [abstract]Clin Res. 1990;38:982A
  8. Hochleitner M, Hörtnagl H, Hörtnagl H, Fridrich L, Gschnitzer F. Long-term efficacy of physiologic dual-chamber pacing in the treatment of end-stage idiopathic dilated cardioymopathy. Am J Cardiol. 1992;15:1320–1325
  9. Furman S. Left ventricular access: Editor's comment. Pacing Clin Electrophysiol. 1998;21:2015[CrossRef][Medline]
  10. Auricchio A, Spinelli JC. Electrical treatment of heart failure: present status. Congestive Heart Failure. 2000;6:325–330
  11. Auricchio A, Geller CJ, Reek S, Goette A, Klein HU. Delayed electrical activation of left bundle branch block and lateral wall in left bundle branch block: insight from 3-D electronatomical mapping. [abstract]J Am Coll Cardiol. 2002;: in press
  12. Hochleitner M, Hörtnagl H, Ng CK, Gschnitzer F, Zechmann W. Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy. Am J Cardiol. 1990;66:198–202[CrossRef][Web of Science][Medline]
  13. Brecker SID, 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]
  14. Nishimura RA, Hayes DL, Holmes DR, Tajik AJ. Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction: an acute doppler and catheterization hemodynamic study. J Am Coll Cardiol. 1995;25:281–288[Abstract]
  15. 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]
  16. Gold MR, Feliciano Z, Gottlieb SS, Fisher ML. Dual-chamber pacing with a short atrioventricular delay in congestive heart failure: a randomized study. J Am Coll Cardiol. 1995;26:967–973[Abstract]
  17. Auricchio A, Salo RW. Acute hemodynamic improvements by pacing in patients with severe congestive heart failure. Pacing Clin Electrophyisiol. 1997;20:313–324
  18. Shibane JS, Chu E, DeMarco T, et al. Evaluation of acute dual chamber pacing with a range of atrioventricular delays on cardiac performance in refractory heart failure. J Am Coll Cardiol. 1997;30:1295–1300[Abstract]
  19. Bakker PF, Meijburg H, de Jonge NL. Beneficial effects of biventricular pacing in congestive heart failure. [abstract]Pacing Clin Electrophysiol. 1994;17:820
  20. Cazeau S, Ritter P, Lazarus A, et al. Multisite pacing for end-stage heart failure: early experience. Pacing Clin Electrophysiol. 1996;19:1748–1757[CrossRef][Medline]
  21. 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]
  22. 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. 1997;99:1567–1573
  23. 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. Circulation. 1999;99:2993–3001[Abstract/Free Full Text]
  24. 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]
  25. Nelson GS, Berger RD, Fetics BJ, et al. Left ventricular or biventricular pacing improves cardiac function at diminuished energy cost in patients with dilated cardiomyopathy and left bundle branch block. Circulation. 2000;102:3053–3059[Abstract/Free Full Text]
  26. Hamdan MH, Zagrodzky JD, Joglar JA et al. Biventricular pacing decrease sympathetic activity compared with right ventricular pacing in patients with depressed ejection fraction. Circulation 102: 1027-32.
  27. Auricchio A, Geller CJ, Kloss M, Klein HU. Cardiac resynchronization therapy guided by 3-D electroanatomic nonfluoroscopic mapping. [abstract]Pacing Clin Electrophysiol. 2001;24:736
  28. Butter C, Auricchio A, Stellbrink C, et al. Should stimulation site be tailored in the individual heart failure patient? Am J Cardiol. 2000;86(suppl 1):K144–K151
  29. Freedman RA, Yock PG, Echt DS, Popp RL. Effect of variation in PQ interval on pattern of atrioventricular valve motion and flow in patients with normal ventricular function. J Am Coll Cardiol. 1986;7:595–602[Abstract]
  30. Ishikawa T, Sumita S, Kimura K, et al. Critical PQ interval for the appearance of diastolic mitral regurgitation and optimal PQ interval in patients implanted with DDD pacemakers. Pacing Clin Electrophysiol. 1994;17:1989–1994[CrossRef][Medline]
  31. Otsuji Y, Gilon D, Jiang L, et al. Restricted diastolic opening of the mitral leafletes in patients with ventriular dysfunction: evidence for increased valve tethering. J Am Coll Cardiol. 1998;32:398–404[Abstract/Free Full Text]
  32. Ogawa S, Hubbard FE, Mardelli TJ, Dreifus LS. Cross-sectional echocardiographic spectrum of papillary muscle dysfunction. Am Heart J. 1979;97:312–321[CrossRef][Web of Science][Medline]
  33. Xiao HB, Brecker SJD, Gibson DG. Differing effects of right ventricular pacing and left bundle branch block on left ventricular function. Br Heart J. 1993;69:166–173[Abstract/Free Full Text]
  34. Auricchio A, Ghanem A, Groethus F, et al. Echocardiographic analysis of left ventricular contraction pattern in left bundle branch block and congestive heart failure. Pacing Clin Electrophysiol. 1999;22:A70
  35. 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]
  36. Brecker SJD, Gibson DG. What is the role of pacing in dilated cardiomyopathy? Eur Heart J. 1996;17:819–824[Free Full Text]
  37. Bakker P, Meijburg H, de Vries JW, et al. Biventricular pacing in end-stage heart failure improves functional capacity and left ventricular function. J Intervent Card Electrophysiol. 2000;4:395–404[CrossRef][Web of Science][Medline]
  38. Auricchio A, Stellbrink C, Sack S, et al, The PATHCHF Study Investigators. The Pacing Therapies for Congestive Heart Failure (PATH-CHF) Study: rationale, design and endpoints of a prospective randomized multicenter study. Am J Cardiol. 1999;83:130D–135D[CrossRef][Web of Science][Medline]
  39. Cazeau S, Leclerque C, Lavergne T, et al, For the Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effect 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]
  40. Stellbrink C, Auricchio A, Butter C, et al. Pacing therapies in congestive heart failure II study. Am J Cardiol. 2000;86:K138–K143
  41. Auricchio A, Carlson G, Kadhiresan V, Hoersch W, Spinelli J, For the PATH-CHF Investigators. Pacing therapy reduces heart rate and increases heart rate variability in CHF patients [abstract]. Pacing Clin Electrophysiol. 1999;22:A–212
  42. Saxon LA, DeMarco T, Chatterjee K, Boehmer J, For the VIGORCHF Investigators. The magnitude of sympathoneural activation in advanced heart failure is altered with chronic biventricular pacing [abstract]. Pacing Clin Electrophysiol. 1998;21:914
  43. Auricehio A, Kloss M, Trautmann SI, Rodner S, Klein HU. Exercise performance following cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. Am J Cardiol. 2002;89:198–203[CrossRef][Web of Science][Medline]
  44. Daoud E, Hummel J, Higgins S, et al. Does ventircular resynchronization therapy influence total survival? [abstract]Pacing Clin Electrophysiol. 2001;24:539[Medline]
  45. Pürerfellner H, Nesser HJ, Winter S, Schwierz T, Hörnell H, Maertens Sfor the EASYTRAK Clinical Study Group and the European EASYTRAK Registry. Transvenous left ventricular lead implantation with the EASYTRAK lead system: the European experience. Am J Cardiol. 2000;86:157K–164K

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



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 Auricchio, A
Right arrow Articles by Klein, H.U
Right arrow Search for Related Content
PubMed
Right arrow Articles by Auricchio, A
Right arrow Articles by Klein, H.U
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?