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J Am Coll Cardiol, 1998; 32:1825-1831
© 1998 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure

Christophe Leclercq, MDa, Serge Cazeau, MD*, Hervé Le Breton, MDa, Philippe Ritter, MD*, Philippe Mabo, MDa, Daniel Gras, MD*, Dominique Pavin, MDa, Arnaud Lazarus, MD* and Jean-Claude Daubert, MDa

a Département de Cardiologie, Hopital Pontchaillou, Rennes, France
* centre chirurgical de val d’or, St. Cloud, France

Manuscript received March 12, 1998; revised manuscript received July 22, 1998, accepted August 20, 1998.

Address for correspondence: Dr. C. Leclercq, Département de Cardiologie, Centre Cardio-Pneumologique, Hopital Pontchaillou, rue Henri le Guilloux, 35033 Rennes Cedex 09, France
leclercq{at}sunaimed.univ-rennes1.fr

Objectives. The aim of this study was to assess the potential acute benefit of multisite cardiac pacing with optimized atrioventricular synchrony and simultaneous biventricular pacing in patients with drug-refractory congestive heart failure (CHF).

Background. Prognosis and quality of life in severe CHF are poor. Various nonpharmacological therapies have been evaluated but are restricted in their effectiveness and applications. In the early 1990s, dual chamber pacing (DDD) pacing was proposed as primary treatment of refractory CHF but results were controversial. Recently, tests to evaluate the effect of simultaneous pacing of both ventricles have elicited a significant improvement of cardiac performance.

Methods. Acute hemodynamic study was conducted in 18 patients with severe CHF (New York Heart Association class III and IV) and major intraventricular conduction block (IVCB) (QRS duration = 170 ± 37 ms). Using a Swan-Ganz catheter, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were measured in different pacing configurations: atrial pacing (AAI) mode, used as reference, single-site right ventricular DDD pacing and biventricular pacing with the right ventricular lead placed either at the apex or at the outflow tract.

Results. The CI was significantly increased by biventricular pacing in comparison with AAI or right ventricular (RV). DDD pacing (2.7 ± 0.7 vs. 2 ± 0.5 and 2.4 ± 0.6 l/min/m2, p < 0.001). The PCWP also decreased significantly during biventricular pacing, compared with AAI (22 ± 8 vs. 27 ± 9 mm Hg; p < 0.001).

Conclusions. This acute hemodynamic study demonstrated that biventricular DDD pacing may significantly improve cardiac performance in patients with IVCB and with severe heart failure, in comparison with intrinsic conduction and single-site RV DDD pacing.

Abbreviations and Acronyms
  AVD = atrioventricular delay
  CHF = congestive heart failure
  CI = cardiac index
  LV = left ventricular
  LVEF = left ventricular ejection fraction
  PAP = pulmonary arterial pressure
  PCWP = pulmonary capillary wedge pressure
  RV = right ventricular
  RVA = right ventricular apex
  RVOT = right ventricular outflow tract




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[Abstract] [Full Text] [PDF]

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A. Duncan, D. Wait, D. Gibson, and J.-C. Daubert
Left ventricular remodelling and haemodynamic effects of multisite biventricular pacing in patients with left ventricular systolic dysfunction and activation disturbances in sinus rhythm: sub-study of the MUSTIC (Multisite Stimulationin Cardiomyopathies) trial
Eur. Heart J., March 1, 2003; 24(5): 430 - 441.
[Abstract] [Full Text] [PDF]

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C. Varma, S. Sharma, S. Firoozi, W. J. McKenna, J.-C. Daubert, and Multisite Stimulation in Cardiomyopathy (MUSTIC) S
Atriobiventricular pacing improves exercise capacity in patients with heart failure and intraventricular conduction delay
J. Am. Coll. Cardiol., February 19, 2003; 41(4): 582 - 588.
[Abstract] [Full Text] [PDF]

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H. Ukkonen, R. S.B. Beanlands, I. G. Burwash, R. A. de Kemp, C. Nahmias, E. Fallen, M. R.S. Hill, and A. S.L. Tang
Effect of Cardiac Resynchronization on Myocardial Efficiency and Regional Oxidative Metabolism
Circulation, January 7, 2003; 107(1): 28 - 31.
[Abstract] [Full Text] [PDF]

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G. Neri, P. Zanco, F. Zanon, and R. Buchberger
Effect of biventricular pacing on metabolism and perfusion in patients affected by dilated cardiomyopathy and left bundle branch block: evaluation by positron emission tomography
Europace, January 1, 2003; 5(1): 111 - 115.
[Abstract] [PDF]

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M. Fatemi, Y. Etienne, M. Gilard, J. Mansourati, and J. J. Blanc
Short and long-term single-centre experience with an S-shaped unipolar lead for left ventricular pacing
Europace, January 1, 2003; 5(2): 207 - 211.
[Abstract] [PDF]

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S. Cazeau, C. Alonso, G. Jauvert, A. Lazarus, and P. Ritter
Cardiac resynchronization therapy
Europace, January 1, 2003; 5(s1): S42 - S48.
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C. Leclercq, S. Walker, C. Linde, J. Clementy, A.J. Marshall, P. Ritter, P. Djiane, P. Mabo, T. Levy, F. Gadler, et al.
Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation
Eur. Heart J., November 2, 2002; 23(22): 1780 - 1787.
[Abstract] [Full Text] [PDF]

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P. Sogaard, H. Egeblad, W. Y. Kim, H. K. Jensen, A. K. Pedersen, B. O. Kristensen, and P. T. Mortensen
Tissue doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy
J. Am. Coll. Cardiol., August 21, 2002; 40(4): 723 - 730.
[Abstract] [Full Text] [PDF]

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H. J. Shenkman, V. Pampati, A. K. Khandelwal, J. McKinnon, D. Nori, S. Kaatz, K. R. Sandberg, and P. A. McCullough
Congestive Heart Failure and QRS Duration* : Establishing Prognosis Study
Chest, August 1, 2002; 122(2): 528 - 534.
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C. Linde, C. Leclercq, S. Rex, S. Garrigue, T. Lavergne, S. Cazeau, W. McKenna, M. Fitzgerald, J.-C. Deharo, C. Alonso, et al.
Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study
J. Am. Coll. Cardiol., July 3, 2002; 40(1): 111 - 118.
[Abstract] [Full Text] [PDF]

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M. Kawaguchi, T. Murabayashi, B. J. Fetics, G. S. Nelson, H. Samejima, E. Nevo, and D. A. Kass
Quantitation of basal dyssynchrony and acute resynchronization from left or biventricular pacing by novel echo-contrast variability imaging
J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2052 - 2058.
[Abstract] [Full Text] [PDF]

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W. T. Abraham, W. G. Fisher, A. L. Smith, D. B. Delurgio, A. R. Leon, E. Loh, D. Z. Kocovic, M. Packer, A. L. Clavell, D. L. Hayes, et al.
Cardiac Resynchronization in Chronic Heart Failure
N. Engl. J. Med., June 13, 2002; 346(24): 1845 - 1853.
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S Garrigue, P Bordachar, S Reuter, P Jais, A Kobeissi, G Gaggini, M Haissaguerre, and J Clementy
Comparison of permanent left ventricular and biventricular pacing in patients with heart failure and chronic atrial fibrillation: prospective haemodynamic study
Heart, June 1, 2002; 87(6): 529 - 534.
[Abstract] [Full Text] [PDF]

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D. Gras, C. Leclercq, A. S.L. Tang, C. Bucknall, H. O. Luttikhuis, and A. Kirstein-Pedersen
Cardiac resynchronization therapy in advanced heart failure the multicenter InSync clinical study
Eur J Heart Fail, June 1, 2002; 4(3): 311 - 320.
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M. Santini and R. Ricci
Biventricular pacing in patients with heart failure and intraventricular conduction delay: state of the art and perspectives. The European view
Eur. Heart J., May 1, 2002; 23(9): 682 - 686.
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D.A Kass
Ventricular dyssynchrony and mechanisms of resynchronization therapy
Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D23 - D30.
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C Stellbrink, A.-M Sinha, B Diem, A Auricchio, S Boccanelli, J Brugada, H Klein, J Morgan, L Padeletti, E Aliot, et al.
Implantable card ioverter-defibrillators with or without cardiac resynchronization therapy -- multiple therapy in a single device: a review with special reference to the PACIVIAN study
Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D88 - D94.
[Abstract] [PDF]

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A Auricchio and H.U Klein
Beyond expectations: a decade of positive results with cardiac resynchronization therapy for heart failure
Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D95 - D101.
[Abstract] [PDF]

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C.-M. Yu, E. Chau, J. E. Sanderson, K. Fan, M.-O. Tang, W.-H. Fung, H. Lin, S.-L. Kong, Y.-M. Lam, M. R.S. Hill, et al.
Tissue Doppler Echocardiographic Evidence of Reverse Remodeling and Improved Synchronicity by Simultaneously Delaying Regional Contraction After Biventricular Pacing Therapy in Heart Failure
Circulation, January 29, 2002; 105(4): 438 - 445.
[Abstract] [Full Text] [PDF]

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C. Leclercq and D. A. Kass
Retiming the failing heart: principles and current clinical status of cardiac resynchronization
J. Am. Coll. Cardiol., January 16, 2002; 39(2): 194 - 201.
[Abstract] [Full Text] [PDF]

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J. P. Bourke, T. Hawkins, P. Keavey, M. Tynan, S. Jamieson, R. Behulova, and S. S. Furniss
Evolution of ventricular function during permanent pacing from either right ventricular apex or outflow tract following AV-junctional ablation for atrial fibrillation
Europace, January 1, 2002; 4(3): 219 - 228.
[Abstract] [PDF]

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E. Oguz, B. Dagdeviren, T. Bilsel, O. Akdemir, I. Erdinler, A. Akyol, T. Ulufer, T. Tezel, and K. Gurkan
Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure
Eur J Heart Fail, January 1, 2002; 4(1): 83 - 90.
[Abstract] [Full Text] [PDF]

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A. Touiza, Y. Etienne, M. Gilard, M. Fatemi, J. Mansourati, and J.-J. Blanc
Long-term left ventricular pacing: assessment and comparison with biventricular pacing in patients with severe congestive heart failure
J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1966 - 1970.
[Abstract] [Full Text] [PDF]

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C Alonso, C Leclercq, F R. d'Allonnes, D Pavin, F Victor, P Mabo, and J-C Daubert
Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: technical aspects
Heart, October 1, 2001; 86(4): 405 - 410.
[Abstract] [Full Text] [PDF]

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Y. Etienne, J. Mansourati, A. Touiza, M. Gilard, V. Bertault-Valls, P. Guillo, J. Boschat, and J. J. Blanc
Evaluation of left ventricular function and mitral regurgitation during left ventricular-based pacing in patients with heart failure
Eur J Heart Fail, August 1, 2001; 3(4): 441 - 447.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
V. Conraads, C. Vrints, J. C. Daubert, S. Cazeau, and C. Leclercq
Biventricular Pacing in Patients with Heart Failure
N. Engl. J. Med., July 26, 2001; 345(4): 293 - 294.
[Full Text] [PDF]

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R.N.W. Hauer, E. Aliot, M. Block, A. Capucci, B. Luderitz, M. Santini, and P.E. Vardas
Indications for implantable cardioverter defibrillator (ICD) therapy. Study Group on Guidelines on ICDs of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology
Eur. Heart J., July 1, 2001; 22(13): 1074 - 1081.
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W Y Kim, P Søgaard, P T Mortensen, H K. Jensen, A K. Pedersen, B O Kristensen, and H Egeblad
Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure
Heart, May 1, 2001; 85(5): 514 - 520.
[Abstract] [Full Text]

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 NEJMHome page
S. Cazeau, C. Leclercq, T. Lavergne, S. Walker, C. Varma, C. Linde, S. Garrigue, L. Kappenberger, G. A. Haywood, M. Santini, et al.
Effects of Multisite Biventricular Pacing in Patients with Heart Failure and Intraventricular Conduction Delay
N. Engl. J. Med., March 22, 2001; 344(12): 873 - 880.
[Abstract] [Full Text] [PDF]


 
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