CAP 124 Heart failure and dual chamber pacemakers: Follow-up after echocardiographic atrioventricular interval adjustement

Abstract The heart rate regularization is crucial for proper treatment of patients with atrial fibrillation and congestive heart failure. The standard resynchronization can be applied, but in patients with narrow QRS this procedure is of no use. The aim of our study is to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using dual chamber ICD implanted for prevention of sudden cardiac death. Methods The study population included 78 patients with CHF and chronic AF: group A - 56 pts treated with direct His-bundle pacing using atrial port of dual chamber ICD and group B - 22 patients implanted with single chamber ICD as recommended by the guidelines. The patients in group B constituting clinical controls were derived from the Heart Failure Outpatients Clinic with established clinical status and pharmacotherapy. Results The demographic data, clinical characteristics and echocardiography measurements at baseline and during follow-up were presented in the table: Table 1 Group A Group B P value Age (years) 69.7±6.9 66.7±11.3 n.s. Sex (% of male sex) 84.0 86.4 n.s. Ventricular pacing (%) – 46.3±31.2 – His-bundle pacing (%) 81.7±9.2 – – pre post pre post pre vs. post LVEDD (mm) 66.9±4.9 59.9±4.7 64.8±8.0 64.7±8.1 <0.01 n.s. EF (%) 29.6±3.8 43.6±5.9 28.1±6.1 28.8±7.3 <0.01 n.s. NYHA class 2.7±0.6 1.4±0.6 2.5±0.6 2.0±0.2 <0.05 n.s. B-blocker dose (metoprolol equivalent dose) 104.6±41.6 214.3±82.6 78.3±56.6 103.1±49.2 <0.001 <0.05 During 12-months of follow-up the mean values of NYHA functional class, EF and LV dimensions did not change in group B but significantly improved in group A. The physiological His-bundle based pacing enabled optimal beta-blocker dosing. The studied groups had no tachyarrhythmia at baseline so the presumable atrial fibrillation-related harm depends on the rhythm irregularity. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The CHF-patients with narrow QRS and chronic AF benefit from substantially higher beta-blockade which can be instituted in His-bundle pacing group.

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Biventricular Pacing in Congestive Heart Failure: Follow-up Data

Nepalese Heart Journal ◽

10.3126/njh.v3i3.26136 ◽

2004 ◽

Vol 3 (3) ◽

pp. 73

Author(s):

N Naik ◽

R Yadav ◽

R Juneja ◽

A Roy ◽

S Anandraja

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Biventricular Pacing ◽

Advanced Heart Failure ◽

Conduction Delay ◽

Dual Chamber ◽

Lv Dysfunction ◽

The Mean

Biventricular (BV) pacing is a promising option for patients with advanced heart failure and electromechanical conduction delay. We present our experience in 17 patients. 19 patients underwent the implant procedure at our institute: 3 others had their implant elsewhere and were on our follow-up. The mean age was 46.6+10.7 years and 14 were males. A conventional indication for pacing was present in 8; 4 of them had previously received a pacemaker. All had severe LV dysfunction. The implant procedure was successful in 12/14- in one the CS lead could not be anchored satisfactorily and a dual chamber device was inserted.

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Biventricular Pacemakers in Patients With Heart Failure

Critical Care Nurse ◽

10.4037/ccn2015942 ◽

2015 ◽

Vol 35 (2) ◽

pp. 20-28 ◽

Cited By ~ 1

Author(s):

Karen Leslie Cooper

Keyword(s):

Heart Failure ◽

Pacemaker Implantation ◽

Dual Chamber ◽

Biventricular Pacemaker ◽

Patients With Heart Failure ◽

Dual Chamber Pacemakers

Patients with heart failure may benefit from implantation of a biventricular pacemaker. This article discusses the indications for biventricular pacemaker implantation and the assessment of patients with biventricular pacemakers. Biventricular pacemakers require more assessments than do traditional single- or dual-chamber pacemakers.

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2166A multicenter echocardiographic comparison on pacemaker-induced tricuspid valve regurgitation: leadless versus transvenous single-chamber and dual-chamber pacing therapy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0094 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N E G Beurskens ◽

J Van Drooge ◽

F Tjong ◽

R Bon ◽

K Dasselaar ◽

...

Keyword(s):

Heart Failure ◽

Tricuspid Valve ◽

Rank Test ◽

Binary Logistic Regression Analysis ◽

Heart Failure Hospitalization ◽

Dual Chamber ◽

Single Chamber ◽

Total Cohort ◽

The Impact

Abstract Background Pacemaker (PM) lead interference with tricuspid valve (TV) function is an important determinant of hemodynamic compromise and is associated with substantial morbidity and mortality. Lead-related TV regurgitation (TR) can potentially be mitigated by leadless pacemaker (LP) therapy by eliminating the presence of a transvalvular lead. Purpose This large multicenter study aimed to evaluate the impact of LP therapy on TV function in comparison with an age –, sex, and follow-up duration -matched cohort of transvenous single-chamber (VVI) and dual-chamber (DDD) PM recipients. Methods Leadless, and transvenous VVI and DDD-PM recipients who underwent an echocardiographic study prior to the procedure and 15±6 months thereafter between January 2013 and September 2018 at two tertiary centers in the Netherlands were included. We used the data of a prospectively acquired population that comprised consecutive patients who underwent LP implantation who were 1:1 matched to transvenous VVI-PM and DDD-PM patients. Results A total of 198 patients (129 males, age 79±8.2 years) were included, of whom 66 were implanted with a LP (two models: Nanostim, Micra LP), and 66 with a transvenous VVI and 66 with DDD-PM. In the total cohort, the Wilcoxon signed-rank test revealed that TR severity was graded more severe in 87 (44%), equally in 104 (53%), and less severe in 7 (4%) patients (p<0.001) compared with baseline echocardiographic findings. Worsening TR was observed in 28 (42%) of the LP (p<0.001) and 34 (52%) of transvenous VVI-PM (p<0.001), and 25 (38%) of the DDD-PM recipients (p<0.01). Binary logistic regression analysis showed that LP recipients were equally prone to increasing TV dysfunction compared with transvenous PMs (p=0.42). Septal position of the leadless intracardiac device (odds ratio 3.6, p=0.03) was associated with worsening TR. In the total cohort, 30 (15%) patients had heart failure hospitalization during the follow-up period. Conclusions TR is a malignant disease which can result in high rates of heart failure hospitalization. This study revealed an unexpected high proportion of patients with worsening TR following LP therapy, yet it was comparable to conventional PM systems. The mechanical impact of the LP near the TV apparatus is the most likely cause of this phenomenon since the septal positioning of the device was associated with increasing TV incompetence. The general consensus was that LP therapy mitigates the risk for TV dyfunction due to the circumvention of transvalvular leads. Therefore, the current results are highly clinically relevant as the contradict expected performance of the LP approach.

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Magnetic Resonance Imaging–Compatible Pacemakers in Comparison with Standard Dual-Chamber Pacemakers in 36-Month Follow-up

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571779 ◽

2016 ◽

Vol 64 (S 01) ◽

Author(s):

G. Göbel ◽

W. Ehrlich ◽

T. Ziegelhoeffer ◽

H. Burger ◽

T. Walther

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Dual Chamber ◽

Dual Chamber Pacemakers

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212 Interest of a new « Mode Switch » function in follow-up of atrial arrhythmias with dual-chamber pacemakers

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(11)70214-2 ◽

2011 ◽

Vol 3 (1) ◽

pp. 68

Author(s):

Marc Hero ◽

Maxime Guenoun

Keyword(s):

Atrial Arrhythmias ◽

Mode Switch ◽

Dual Chamber ◽

Dual Chamber Pacemakers

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P6545Pacing as new predictor for atrial high rate episodes in patients with dual-chamber pacemakers and no history of atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz746.1135 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Benezet Mazuecos ◽

A Devesa Arbiol ◽

C S Garcia Talavera ◽

J A Iglesias ◽

E Serrano ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Events ◽

Pacemaker Implantation ◽

High Rate ◽

Prior History ◽

Dual Chamber ◽

Cardiac Implantable Electronic Devices ◽

History Of ◽

Dual Chamber Pacemakers

Abstract Introduction Both atrial and ventricular pacing (AP/VP) have been related to a higher risk of clinical atrial fibrillation (AF) documented on ECG. Subclinical AF is detected as atrial high rate episodes (AHRE) by cardiac implantable electronic devices and is related to a higher risk of stroke. Purpose The aim of this study was to determine whether the percentage of AP and/or VP in patients with pacemakers and no history of AF is related with the future development of subclinical AF (AHRE) and/or clinical AF (ECG documented). Methods From February 2012 to September 2015 we recruited patients with dual chamber pacemakers and no prior history of AF. Patients were followed at 3 months and every year then after. Subclinical AF, clinical AF and cardiovascular events were registered. AHRE (subclinical AF) was defined as an episode of atrial rate ≥225 bpm with a minimum duration of 5 min. Clinical AF was defined as ECG documented AF. Percentage of AP/VP was determined as the mean AP/VP during the first three visits. Mortality and cardiovascular events (including AF, stroke and hospitalization for heart failure) were also recorded. Results 249 patients (57% men; 75±9 years-old) were included. Mean time from pacemaker implantation was 9 months and the main indication was AV-block in 53% of the patients. Mean CHA2DS2-VASc score was 3.5±1.5. After a mean follow-up of 33±11 months, 38.5% of patients developed subclinical AF and 10.4% clinical AF. Patients with AP≥50% presented significantly higher risk of AHRE (62.5% vs 32.3%, OR 3.48; 95% CI [1.93–6.4] p<0.01) and clinical AF (18.7% vs 8.6%, OR 2.4; 95% CI [1.05–5.52] p<0.05). Patients with VP≥50% presented significantly higher risk of AHRE (46.4% vs 31.6%, OR 1.87; 95% CI [1.10–3.24] p<0.05) and clinical AF (25.9% vs 9.7%, OR 2.7; 95% CI [1.13–7.72] p<0.05). The percentage of AP and VP were not related to a higher risk of cardiovascular events or mortality. Multivariate analysis showed that AP≥50% was an independent predictor for AHRE (OR 2.4; 95% CI [1.19–4.97] p=0.014). Conclusions Pacing is related to a higher risk for developing subclinical and clinical AF in patients with dual-chamber pacemakers and no history of previous AF. Our data suggest, that patients presenting a high percentage of AP and VP should be closely followed during routinely pacemaker check-ups assessing for subclinical AF, especially in those with AP ≥50%.

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