© 2004 by European Society of Cardiology
ORIGINAL ARTICLE
Assessment of upgrading to biventricular pacing in patients with right ventricular pacing and congestive heart failure after atrioventricular junctional ablation for chronic atrial fibrillation
Department of Cardiology, Brest University Hospital 29609 Brest Cedex, France
AIMS: Effects of cardiac resynchronization therapy (CRT) in patients with right ventricular pacing and congestive heart failure (CHF) have only been reported in limited series. CRT in patients with atrial fibrillation remains controversial. Patients with AV junctional ablation offer a unique opportunity to study the effects of CRT in patients with right ventricular pacing combined with atrial fibrillation.
The aims of the present study were to evaluate the effects of upgrading to biventricular pacing patients with CHF, permanent atrial fibrillation, and prior ablation of the atrioventricular (AV) junction followed by conventional right ventricular pacing.
METHODS AND RESULTS: We studied 16 consecutive patients with permanent atrial fibrillation treated by AV junctional ablation. After a mean follow-up of 20±19 months (6 weeks to 5 years) they were successfully upgraded to biventricular pacing for severe CHF. Parameters were prospectively evaluated at baseline and at 6 months.
The 14 surviving patients at 6 months demonstrated significant improvement (P<0.02) in New York Heart Association class but the exercise test parameters remained unchanged. Cardiothoracic ratio decreased by 5% (P=0.04), end-systolic diameter by 8% (P=0.001), end-diastolic diameter by 4% (P=0.08), systolic pulmonary artery pressure by 17% (P<0.0001) and mitral regurgitation area by 40% (P<0.05). Ejection fraction increased by 17% (P=0.11) and fractional shortening by 24% (P=0.01).
CONCLUSION: CRT improves left ventricular performance and functional status in patients with permanent atrial fibrillation and prior remote right ventricular pacing.
Key Words: resynchronization, atrial fibrillation, congestive heart failure, atrioventricular junctional ablation
*Corresponding author. Tel.: +33-298-347392; fax: +33-298-347803. E-mail address: jean-jacques.blanc{at}univ-brest.fr (J.-J. Blanc).
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. B. Kronborg, J. C. Nielsen, and P. T. Mortensen Electrocardiographic patterns and long-term clinical outcome in cardiac resynchronization therapy Europace, November 14, 2009; (2009) eup364v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. F. Tops, M. J. Schalij, and J. J. Bax The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 764 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schmidt, H. Rittger, H. Marschang, A.-M. Sinha, M. Daccarett, J. Brachmann, M. Block, and O. A. Breithardt Left ventricular dyssynchrony from right ventricular pacing depends on intraventricular conduction pattern in intrinsic rhythm Eur J Echocardiogr, August 1, 2009; 10(6): 776 - 783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W.X. Foley, S. A. Muhyaldeen, S. Chalil, R. E.A. Smith, J. E. Sanderson, and F. Leyva Long-term effects of upgrading from right ventricular pacing to cardiac resynchronization therapy in patients with heart failure Europace, April 1, 2009; 11(4): 495 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Proclemer, G. Allocca, D. Gregori, C. Bonanno, R. Ometto, A. Fontanelli, R. Mantovan, M. Crosato, V. Calzolari, D. Pavoni, et al. Radiofrequency ablation of drug-refractory atrial fibrillation: an observational study comparing 'ablate and pace' with pulmonary vein isolation Europace, September 1, 2008; 10(9): 1085 - 1090. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Khadjooi, P W Foley, S Chalil, J Anthony, R E A Smith, M P Frenneaux, and F Leyva Long-term effects of cardiac resynchronisation therapy in patients with atrial fibrillation Heart, July 1, 2008; 94(7): 879 - 883. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]
|
|
|
|
|
|
G. Z. Duray, C. W. Israel, D. Pajitnev, and S. H. Hohnloser Upgrading to biventricular pacing/defibrillation systems in right ventricular paced congestive heart failure patients: prospective assessment of procedural parameters and response rate Europace, January 1, 2008; 10(1): 48 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Shimano, Y. Tsuji, Y. Yoshida, Y. Inden, N. Tsuboi, T. Itoh, H. Suzuki, T. Muramatsu, T. Okada, S. Harata, et al. Acute and chronic effects of cardiac resynchronization in patients developing heart failure with long-term pacemaker therapy for acquired complete atrioventricular block Europace, October 1, 2007; 9(10): 869 - 874. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Schoenfeld Alternative Site Pacing to Promote Cardiac Synchrony: Has Conventional Pacing Become Unconventional? J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1946 - 1948. [Full Text] [PDF]
|
|
|
|
|
|
M. Kindermann, B. Hennen, J. Jung, J. Geisel, M. Bohm, and G. Frohlig Biventricular Versus Conventional Right Ventricular Stimulation for Patients With Standard Pacing Indication and Left Ventricular Dysfunction: The Homburg Biventricular Pacing Evaluation (HOBIPACE) J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1927 - 1937. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Dilaveris, A. Pantazis, G. Giannopoulos, A. Synetos, J. Gialafos, and C. Stefanadis Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick? Europace, January 1, 2006; 8(5): 352 - 357. [Abstract] [Full Text] [PDF]
|
|