CLINICAL STUDIES
Ventricular contraction abnormalities in dilated cardiomyopathy: effect of biventricular pacing to correct interventricular dyssynchrony
Walter F. Kerwin, MDa,
Elias H. Botvinick, MD, FACCa,
J. William O’Connell, MSa,
Scot H. Merrick, MD, FACCa,
Teresa DeMarco, MD, FACCa,
Kanu Chatterjee, MB, FACCa,
Kim Scheibly, RNa and
Leslie A. Saxon, MD, FACCa
a Division of Cardiology, Department of Medicine, University of California, San Francisco, California, USA
Manuscript received August 20, 1999;
revised manuscript received November 19, 1999,
accepted January 5, 2000.
Reprint requests and correspondence: Dr. Leslie A. Saxon, University of California, San Francisco, 500 Parnassus Avenue, MU East, Box 1354, San Francisco, California 94143-1354
saxon{at}ep4.ucsf.edu
OBJECTIVE
To measure ventricular contractile synchrony in patients with dilated cardiomyopathy (DCM) and to evaluate the effects of biventricular pacing on contractile synchrony and ejection fraction.
BACKGROUND
Dilated cardiomyopathy is characterized by abnormal ventricular activation and contraction. Biventricular pacing may promote a more coordinated ventricular contraction pattern in these patients. We hypothesized that biventricular pacing would improve synchrony of right ventricular and left ventricular (RV/LV) contraction, resulting in improved ventricular ejection fraction.
METHODS
Thirteen patients with DCM and intraventricular conduction delay underwent multiple gated equilibrium blood pool scintigraphy. Phase image analysis was applied to the scintigraphic data and mean phase angles computed for the RV and LV. Phase measures of interventricular (RV/LV) synchrony were computed in sinus rhythm and during atrial sensed biventricular pacing (BiV).
RESULTS
The degree of interventricular dyssynchrony present in normal sinus rhythm correlated with LV ejection fraction (r = –0.69, p < 0.01). During BiV, interventricular contractile synchrony improved overall from 27.5 ± 23.1° to 14.1 ± 13° (p = 0.01). The degree of interventricular dyssynchrony present in sinus rhythm correlated with the magnitude of improvement in synchrony during BiV (r = 0.83, p < 0.001). Left ventricular ejection fraction increased in all thirteen patients during BiV, from 17.2 ± 7.9% to 22.5 ± 8.3% (p < 0.0001) and correlated significantly with improvement in RV/LV synchrony during BiV (r = 0.86, p < 0.001).
CONCLUSIONS
Dilated cardiomyopathy with intraventricular conduction delay is associated with significant interventricular dyssynchrony. Improvements in interventricular synchrony during biventricular pacing correlate with acute improvements in LV ejection fraction.
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Abbreviations and Acronyms
| | AV | = atrioventricular | | BiV | = atrial synchronized biventricular pacing | | CS | = coronary sinus | | DCM | = dilated cardiomyopathy | | EDC | = end-diastolic counts | | EF | = ejection fraction | | ESC | = end-systolic counts | | IVCD | = nonspecific intraventricular conduction delay | | LBBB | = left bundle branch block | | LV | = left ventricle or ventricular | | NYHA | = New York Heart Association functional class | | RBBB | = right bundle branch block | | RV | = right ventricle or ventricular |
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April 17, 2002;
39(8):
1258 - 1263.
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A. Auricchio, J. Ding, J. C. Spinelli, A. P. Kramer, R. W. Salo, W. Hoersch, B. H. KenKnight, H. U. Klein, and for the PATH-CHF Study Group
Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay
J. Am. Coll. Cardiol.,
April 3, 2002;
39(7):
1163 - 1169.
[Abstract]
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C Varma, P O'Callaghan, N G Mahon, K Hnatkova, W McKenna, A J Camm, E Rowland, and S J D Brecker
Effect of multisite pacing on ventricular coordination
Heart,
April 1, 2002;
87(4):
322 - 328.
[Abstract]
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L. A. Saxon, T. De Marco, J. Schafer, K. Chatterjee, U. N. Kumar, and E. Foster
Effects of Long-Term Biventricular Stimulation for Resynchronization on Echocardiographic Measures of Remodeling
Circulation,
March 19, 2002;
105(11):
1304 - 1310.
[Abstract]
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G. Ansalone, P. Giannantoni, R. Ricci, P. Trambaiolo, F. Fedele, and M. Santini
Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing
J. Am. Coll. Cardiol.,
February 6, 2002;
39(3):
489 - 499.
[Abstract]
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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]
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L. A. Saxon and T. De Marco
Cardiac resynchronization: a cornerstone in the foundation of device therapy for heart failure
J. Am. Coll. Cardiol.,
December 1, 2001;
38(7):
1971 - 1973.
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S. S. Barold
Biventricular Cardiac Pacing : Promising New Therapy for Congestive Heart Failure
Chest,
December 1, 2000;
118(6):
1819 - 1821.
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J. A. Morris-Thurgood, M. S. Turner, A. K. Nightingale, N. Masani, C. Mumford, and M. P. Frenneaux
Pacing in heart failure: improved ventricular interaction in diastole rather than systolic re-synchronization
Europace,
January 1, 2000;
2(4):
271 - 275.
[Abstract]
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M. Henein
Ventricular interaction: effect of pacing in heart failure
Europace,
January 1, 2000;
2(4):
276 - 276.
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