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Right ventricular pacing improves haemodynamics in right ventricular failure from pressure overload: an open observational proof-of-principle study in patients with chronic thromboembolic pulmonary hypertension.
Europace. 2011 Dec; 13(12):1753-9.E

Abstract

AIMS

Right ventricular (RV) failure in patients with chronic thromboembolic pulmonary hypertension (CTEPH), and other types of pulmonary arterial hypertension is associated with right-to-left ventricle (LV) delay in peak myocardial shortening and, consequently, the onset of diastolic relaxation. We aimed to establish whether RV pacing may resynchronize the onsets of RV and LV diastolic relaxation, and improve haemodynamics.

METHODS AND RESULTS

Fourteen CTEPH patients (mean age 63.7 ± 12.0 years, 10 women) with large (≥60 ms) RV-to-LV delay in the onset of diastolic relaxation (DIVD, diastolic interventricular delay) were studied. Temporary RV pacing was performed by atrioventricular (A-V) sequential pacing with incremental shortening of A-V delay to advance RV activation. Effects were assessed using tissue Doppler echocardiography and LV pressure-conductance catheter measurements in a subset of patients. Compared with right atrial pacing, RV pacing at optimal A-V delay (average 140 ± 22 ms, range 120-180 ms) resulted in significant DIVD reduction (59 ± 19 to 3 ± 22 ms, P < 0.001), and increase in LV stroke volume as measured by LV outflow tract velocity-time integral (14.9 ± 2.8 to 16.9 ± 3.0 cm, P < 0.001), along with enhanced global RV contractility and LV diastolic filling.

CONCLUSION

Right-to-left ventricle resynchronization of the onset of diastolic relaxation results in stroke volume increase in CTEPH patients. Whether RV pacing may be a novel therapeutic target in RV failure following chronic pressure overload remains to be investigated.

Authors+Show Affiliations

Heart Failure Research Center , Academic Medical Center, University of Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21784747

Citation

Hardziyenka, Maxim, et al. "Right Ventricular Pacing Improves Haemodynamics in Right Ventricular Failure From Pressure Overload: an Open Observational Proof-of-principle Study in Patients With Chronic Thromboembolic Pulmonary Hypertension." Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, vol. 13, no. 12, 2011, pp. 1753-9.
Hardziyenka M, Surie S, de Groot JR, et al. Right ventricular pacing improves haemodynamics in right ventricular failure from pressure overload: an open observational proof-of-principle study in patients with chronic thromboembolic pulmonary hypertension. Europace. 2011;13(12):1753-9.
Hardziyenka, M., Surie, S., de Groot, J. R., de Bruin-Bon, H. A., Knops, R. E., Remmelink, M., Yong, Z. Y., Baan, J., Bouma, B. J., Bresser, P., & Tan, H. L. (2011). Right ventricular pacing improves haemodynamics in right ventricular failure from pressure overload: an open observational proof-of-principle study in patients with chronic thromboembolic pulmonary hypertension. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 13(12), 1753-9. https://doi.org/10.1093/europace/eur189
Hardziyenka M, et al. Right Ventricular Pacing Improves Haemodynamics in Right Ventricular Failure From Pressure Overload: an Open Observational Proof-of-principle Study in Patients With Chronic Thromboembolic Pulmonary Hypertension. Europace. 2011;13(12):1753-9. PubMed PMID: 21784747.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right ventricular pacing improves haemodynamics in right ventricular failure from pressure overload: an open observational proof-of-principle study in patients with chronic thromboembolic pulmonary hypertension. AU - Hardziyenka,Maxim, AU - Surie,Sulaiman, AU - de Groot,Joris R, AU - de Bruin-Bon,H A C M Rianne, AU - Knops,Reinoud E, AU - Remmelink,Maurice, AU - Yong,Ze-Yie, AU - Baan,Jan,Jr AU - Bouma,Berto J, AU - Bresser,Paul, AU - Tan,Hanno L, Y1 - 2011/07/21/ PY - 2011/7/26/entrez PY - 2011/7/26/pubmed PY - 2012/7/3/medline SP - 1753 EP - 9 JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JO - Europace VL - 13 IS - 12 N2 - AIMS: Right ventricular (RV) failure in patients with chronic thromboembolic pulmonary hypertension (CTEPH), and other types of pulmonary arterial hypertension is associated with right-to-left ventricle (LV) delay in peak myocardial shortening and, consequently, the onset of diastolic relaxation. We aimed to establish whether RV pacing may resynchronize the onsets of RV and LV diastolic relaxation, and improve haemodynamics. METHODS AND RESULTS: Fourteen CTEPH patients (mean age 63.7 ± 12.0 years, 10 women) with large (≥60 ms) RV-to-LV delay in the onset of diastolic relaxation (DIVD, diastolic interventricular delay) were studied. Temporary RV pacing was performed by atrioventricular (A-V) sequential pacing with incremental shortening of A-V delay to advance RV activation. Effects were assessed using tissue Doppler echocardiography and LV pressure-conductance catheter measurements in a subset of patients. Compared with right atrial pacing, RV pacing at optimal A-V delay (average 140 ± 22 ms, range 120-180 ms) resulted in significant DIVD reduction (59 ± 19 to 3 ± 22 ms, P < 0.001), and increase in LV stroke volume as measured by LV outflow tract velocity-time integral (14.9 ± 2.8 to 16.9 ± 3.0 cm, P < 0.001), along with enhanced global RV contractility and LV diastolic filling. CONCLUSION: Right-to-left ventricle resynchronization of the onset of diastolic relaxation results in stroke volume increase in CTEPH patients. Whether RV pacing may be a novel therapeutic target in RV failure following chronic pressure overload remains to be investigated. SN - 1532-2092 UR - https://www.unboundmedicine.com/medline/citation/21784747/Right_ventricular_pacing_improves_haemodynamics_in_right_ventricular_failure_from_pressure_overload:_an_open_observational_proof_of_principle_study_in_patients_with_chronic_thromboembolic_pulmonary_hypertension_ L2 - https://academic.oup.com/europace/article-lookup/doi/10.1093/europace/eur189 DB - PRIME DP - Unbound Medicine ER -