PubMed · 15825840
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Dorin Panescu. Cardiac resynchronization therapy.. https://doi.org/10.1109/memb.2005.1411342
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Chronic heart failure with its age-dependent prevalence and incidence is one of the most frequent diseases. Due to high mortality and morbidity there is the necessity of early diagnosis and therapeutic measures being as causal as possible. The medical graded therapy is based on the combination of ACE-inhibitors/AT1-blockers, beta-blockers, diuretics and digitalis. Cardiac resynchronization therapy represents a novel option of treatment for only 25% of patients. Nevertheless the prognosis of patients with chronic heart failure with conventional medical therapy is remaining poor. Additional improvement in the treatment of patient with chronic heart failure remains a priority medical task. The results of this case report argues for CPAP as further adjunctive treatment option in patients with chronic heart failure.
BACKGROUND: This study evaluates the acute and chronic resynchronizing effects of AV sequential left ventricular (LV) pacing on LV function in patients with impaired cardiac function and conduction disorders by 3-dimensional transesophageal echocardiography. METHODS AND RESULTS: Twenty-nine patients with congestive heart failure, with LV ejection fraction (LVEF) < or = 30%, QRS duration > or = 120 milliseconds, and New York Heart Association Class II to IV, were implanted with a cardiac resynchronization device using an LV lead only, according to the invasively determined hemodynamic optimal pacing site and AV delay. Patients underwent 3-dimensional transesophageal echocardiography before randomization to treatment (baseline) and at 12-month follow-up (resynchronization--12 months). Three-dimensional volumes were acquired on resynchronization and during intermittent switch-off at intrinsic depolarization. The values of stroke volume were 43.2 +/- 13.3 (intrinsic-baseline), 51.7 +/- 17.4 (intrinsic--12 months), 57.2 +/- 15.6 (resynchronization-baseline), and 64.6 +/- 18.9 (resynchronization--12 months). Analysis of variance demonstrated a significant effect of resynchronization at different periods (P < .001) and a significant time effect (P < .05) for stroke volume. Similar results were observed with ejection fraction (LVEF). No effect was observed with LV end-diastolic volume, whereas a therapy effect with no time effect was observed with LV end-systolic volume. CONCLUSIONS: A significant acute increase of LV stroke volume and LVEF was found by resynchronization by LV pacing alone. A continuous improvement of LV stroke volume and LVEF occurred with time of follow-up (reverse remodeling). The initial therapeutic effect persisted during 12-month follow-up independently of time of follow-up and QRS width. No significant decrease of LV end-diastolic size during chronic resynchronization was detected in contrast to previous studies with resynchronization by biventricular pacing.
The number of patients who have cardiac pacemakers has increased markedly over the past few decades since the technology was first introduced in the 1950s. Advances in technology, expanding indications, and the aging of the population ensure that clinicians will encounter patients with cardiac pacemakers on a regular basis. This article summarizes the electrocardiographic manifestations of the normally functioning permanent cardiac pacemaker and abnormalities associated with pacemaker malfunction.