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Cardiac Resynchronization Therapy in Patients with Right Ventricular Pacing‐Induced Cardiomyopathy
Author(s) -
NAZERI ALIREZA,
MASSUMI ALI,
RASEKH ABDI,
SAEED MOHAMMAD,
FRANK CHRISTOPHER,
RAZAVI MEHDI
Publication year - 2010
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02594.x
Subject(s) - medicine , ejection fraction , cardiac resynchronization therapy , cardiology , cardiomyopathy , heart failure , dilated cardiomyopathy , ischemic cardiomyopathy
Background:It is not known whether patients with normal baseline left ventricular (LV) function who develop right ventricular (RV) pacing‐induced cardiomyopathy as a result of dual‐chamber pacing can benefit from cardiac resynchronization therapy (CRT). We retrospectively assessed the effect of a CRT upgrade on RV pacing‐induced cardiomyopathy.Methods and Results:We reviewed the charts of patients who received a CRT device for RV pacing‐induced cardiomyopathy. We assessed the effects of CRT on LV function, recovery, and other response parameters. From September 2005 through February 2009, 21 patients (13 men; aged 63 ± 9 years) underwent a treatment upgrade to a CRT system. Before the dual‐chamber pacemaker was implanted, the LV ejection fraction (LVEF) was 53 ± 2.3%. After pacing, the LVEF was 31.2 ± 3.8%, the LV end‐diastolic dimension (LVEDD) was 5.8 ± 0.5 cm, and B‐type natriuretic peptide (BNP) levels were 426 ± 149 pg/mL. The duration of pacing before documentation of pacing‐induced cardiomyopathy was 3.8 ± 1.5 months. All the patients had been on a stable medical regimen for at least 2 months. After the upgrade to CRT, the follow‐up time was 4.9 ± 0.9 months. Sixteen patients (76%) reported a significant improvement in their symptoms. After the CRT upgrade, the LVEF increased to 37.4 ± 9.0% (P < 0.01 vs pre‐CRT). The LVEDD decreased to 5.0 ± 1.0 cm (P = 0.03 vs pre‐CRT), and BNP levels decreased to 139 ± 92 pg/mL (P = 0.08 vs pre‐CRT).Conclusion:A CRT upgrade is an effective treatment for RV pacing‐induced cardiomyopathy and should be implemented as soon as the diagnosis is established. Unfortunately, about 24% of our patients did not respond to the upgrade. (PACE 2010; 37–40)