Work

Cardiac Resynchronization Therapy

Year: 2011

Type: article

Abstract: Background and objectives: The role of right (R) and left (L) ventricular (V) reverse remodelling in symptom improvement after biventricular upgrade is unclear.Methods: Tomographic radionuclide angiocardiographic RV and LV end-diastolic (EDV, mL) and end-systolic (ESV, mL) and New York Heart Association heart failure class (NYHA) were determined before and 3 -6 months after upgrading from persistent RV pacing to persistent biventricular pacing in 19 patients.Results: Symptoms improved (a decline in at least one NYHA class) in 9 patients (2.89 + 0.33 to 1.67 + 0.5) with no improvement in 10 (2.6 + 0.52 to 2.6 + 0.52).During chronic RV pacing and before biventricular upgrade, patients with symptom compared with those without symptom improvement had significantly larger LV EDV (221 + 75 vs.160 + 42, P ¼ 0.04).After biventricular upgrade, in patients with symptom improvement, significant declines in LV EDV (221 + 75 to 180 + 54, P ¼ 0.04) and ESV (147 + 58 to 109 + 46, P ¼ 0.01) occurred; no significant changes occurred in RV EDV (256 + 64 vs. 220 + 33) and ESV (157 + 74 vs. 122 + 43).After biventricular upgrade, patients without symptomatic improvement showed no significant changes in LV and RV volumes.Conclusions: Symptomatic improvement after upgrading from chronic RV to biventricular pacing was associated with a larger baseline LV EDV and subsequent significant reduction in LV EDV and ESV.Reverse remodelling of the LV but not the RV after biventricular pacing upgrade was associated with symptom improvement.

Source: EP Europace

DOI: 10.1093/europace/euq477