Europace Advance Access published online on May 21, 2007
Europace, doi:10.1093/europace/eum081
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Improvement in cardiac adrenergic function post biventricular pacing for heart failure
1 Wynn Department of Metabolic Cardiology, Baker Heart Research Institute, PO Box 6492, St Kilda Road Central, Melbourne VIC 3004, Australia; 2 Department of Nuclear Medicine, Alfred Hospital, Melbourne, Australia; 3 Alfred Heart Centre, Alfred Hospital, Melbourne, Australia
Aims We investigated whether biventricular (BiV) pacing favourably affects cardiac sympathetic activity in heart failure (HF).
Methods and results In 10 HF patients treated with BiV pacing, we assessed cardiac sympathetic activity by metaiodobenzylguanidine (123I-MIBG) imaging. Patients were randomized in a double-blinded crossover fashion, for two weeks of either inactivation of BiV pacing or BiV pacing, with crossover to the alternate group for a further two weeks. After randomization blocks, cardiac 123I-MIBG imaging and a 6 min walk test were performed. BiV pacing was associated with significant improvements in cardiac 123I-MIBG uptake reflected by increases in early (BiV 1.71 ± 0.09 vs. non-BiV 1.63 ± 0.06, P = 0.03) and late (at 4 h) heart to mediastinal ratio of uptake (BiV 1.54 ± 0.08 vs. non-BiV 1.45 ± 0.06, P = 0.03). Additionally, pulmonary 123I-MIBG uptake, measured as lung to mediastinal ratio, significantly improved (P = 0.009). Six-minute walk and systolic blood pressure tended to improve with BiV vs. non-BiV pacing (P = 0.09).
Conclusion In patients with stable HF, BiV pacing is associated with long-term improvements in cardiac sympathetic nerve activity, as reflected by improvements in cardiac 123I-MIBG uptake. This is a potential mechanism for morbidity and mortality benefits observed in larger studies.
Key Words: Biventricular pacing, Heart failure, Sympathetic activity, Cardiac 123I-MIBG scanning
* Corresponding author. Tel: +61 3 9207 1044; fax: +61 3 9207 1075. E-mail address: david.kaye{at}baker.edu.au
Manuscript submitted 27 August 2006. Accepted after revision 2 April 2007.
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