Potential Prevention of Pacing-Induced Heart Failure Using Simple Pacemaker Programming Algorithm

Introduction Right ventricular pacing (RVP) causes ventricular desynchronization and may lead to the development of heart failure (HF). Prolongation of atrioventricular delay (AVD) in DDDR pacemakers reduces unnecessary RV stimulation. The aim of the study was to verify the influence of RVP reductio...

Full description

Saved in:
Bibliographic Details
Published in:Annals of noninvasive electrocardiology 2013-07, Vol.18 (4), p.369-378
Main Authors: Chwyczko, Tomasz, Dąbrowski, Rafał, Maciąg, Aleksander, Sterliński, Maciej, Smolis-Bąk, Edyta, Borowiec, Anna, Kowalik, Ilona, Łabęcka, Andrada, Jankowska, Agnieszka, Kośmicki, Marek, Janas, Jadwiga, Pytkowski, Mariusz, Szwed, Hanna
Format: Article
Language:English
Subjects:
Aged
Algorithms
BNP
Cardiac Pacing, Artificial - adverse effects
Cardiac Pacing, Artificial - methods
cardiopulmonary exercise
Cross-Over Studies
echocardiography
Echocardiography, Doppler - methods
Electrocardiography
Female
Follow-Up Studies
Heart Failure - etiology
Heart Failure - prevention & control
Heart Function Tests
Humans
Male
Middle Aged
Natriuretic Peptide, Brain - analysis
Original
Pacemaker, Artificial
pacing
Prospective Studies
Risk Assessment
Severity of Illness Index
Sick Sinus Syndrome - diagnosis
Sick Sinus Syndrome - therapy
Single-Blind Method
sinus node dysfunction
Treatment Outcome
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - prevention & control
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction Right ventricular pacing (RVP) causes ventricular desynchronization and may lead to the development of heart failure (HF). Prolongation of atrioventricular delay (AVD) in DDDR pacemakers reduces unnecessary RV stimulation. The aim of the study was to verify the influence of RVP reduction on HF symptoms. Methods The study comprised 31 patients (17 men, mean age: 71.6 ± 8 yrs) with DDDR pacemaker implanted due to sinus node dysfunction (SND). At baseline, 28 patients did not present any symptoms of HF. Three patients were in NYHA class II. Patients were randomized either to 150 ms AVD or to minimizing right ventricular pacing (MRVP). Crossing over to the alternate mode took place after 4 months. Cardiopulmonary exercise test (CPX), echocardiography (ECHO) and BNP measurements were done before pacemaker implantation, after 4 and 8 months. Results The percentage of RVP was significantly higher in 150 ms AVD than in MRVP: 81.7 ± 22.6 versus 14.2±20.5%, P < 0.0001. Patients with 150 ms mode had worse CPX parameters than those with MRVP mode: peak oxygen uptake was 14.2±4.3 versus 19.9±6.3 ml/kg per min, P = 0.0001, higher BNP concentrations: 72.3±48.3 versus 49.4±43.9 pg/ml, P = 0.001 and worse left ventricle [LV] function: ejection fraction: 53.2±6.7 versus 57.3±5.5%, P < 0.0001; LV diastolic diameter: 4.86±0.52 versus 4.66±0.5 cm, P < 0.01. Conclusion Predominant RVP in patients without symptoms of HF at baseline may be responsible for worse performance in cardiopulmonary exercise test, higher BNP concentrations and impairment of LV function. Specific DDDR pacemaker programming promotes intrinsic AV conduction and may prevent the development of pacing‐induced HF.
ISSN:1082-720X
1542-474X
DOI:10.1111/anec.12049