Does cardiac resynchronization therapy (CRT) upgrade improve cardiac function and symptoms in patients developing heart failure during long-term right ventricular apical pacing for acquired complete atrioventricular block?
Upgrading to cardiac resynchronization therapy significantly improves left ventricular function, symptoms, and reduces hospitalizations in patients who develop heart failure induced by long-term right ventricular apical pacing.
AIMS: We assessed the effects of cardiac re-synchronization therapy (CRT) in patients who developed otherwise unexplained heart failure (HF) during right ventricular apical (RVA)-pacing for acquired complete atrioventricular block (CAVB). METHODS AND RESULTS: Eighteen consecutive CAVB patients with HF during RVA-pacing were assessed with haemodynamic studies immediately and 12 months after CRT-upgrade. Ten patients had idiopathic CAVB and 13 showed normal left ventricular (LV) function at RVA-pacemaker implantation. HF developed after 81 +/- 10 months. RVA-pacing duration correlated (r = 0.49, P 5 years (7.7 +/- 2.5 vs. 3.6 +/- 1.0 mm, P = 0.08). CONCLUSION: CRT-upgrade improves the cardiac function and symptoms in CAVB patients with HF progression related to RVA-pacing. Because adverse LV-remodelling may be partly irreversible, consideration should be given to BiV- and LV-pacing upgrade as soon as possible after the indications appear, and prospective studies of the optimal timing of CRT-upgrade may be useful.
Shimano et al. (Fri,) studied this question.
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