Effects of resynchronization therapy on sympathetic activity in patients with depressed ejection fraction and intraventricular conduction delay due to ischemic or idiopathic dilated cardiomyopathy

doi:10.1016/S0002-9149(02)02273-7

The American Journal of Cardiology

Volume 89, Issue 9, 1 May 2002, Pages 1047-1051

https://doi.org/10.1016/S0002-9149(02)02273-7 Get rights and content

Abstract

This study assesses the effect of biventricular pacing on sympathetic nerve activity (SNA) in patients with depressed ejection fraction and intraventricular conduction delay (IVCD). Biventricular pacing has been shown to result in hemodynamic improvement in patients with depressed ejection fraction and IVCD. The effect of biventricular pacing on SNA, however, remains unclear. A total of 15 men with a mean ejection fraction of 25 ± 4% were enrolled. Arterial pressure, central venous pressure and SNA were recorded during 3 minutes of right atrial (RA) pacing and RA-biventricular pacing. Pacing was performed at a rate 5 to 10 beats faster than sinus rhythm, with an atrioventricular interval equal to 100 ms during RA-biventricular pacing. RA-biventricular pacing resulted in greater arterial pressures (p <0.05) than RA pacing (146 ± 15/83 ± 11 vs 141 ± 15/80 ± 10 mm Hg). There were no differences in central venous pressures between the 2 pacing modes (p = 0.76). SNA was significantly less during RA-biventricular pacing (727 ± 242 U) than during RA pacing (833 ± 332 U) (p <0.02). Furthermore, there was a positive correlation between baseline QRS duration and the decrease in SNA noted with RA-biventricular pacing (r = 0.58, p = 0.03). Biventricular pacing results in improved hemodynamics and a decrease in SNA compared with intrinsic conduction in patients with left ventricular dysfunction and IVCD. If the current findings are also present with chronic biventricular pacing, then this form of therapy may have a positive impact on mortality.

Section snippets

Patients:

The study was performed at the Dallas Veterans Affairs Medical Center and was approved by the institutional review board. Informed consent was obtained from all patients and all procedures were in accordance with institutional guidelines. All patients with a clinical indication for programmed electrical stimulation, a depressed ejection fraction (<35%) and IVCD (QRS >100 ms) were screened for the study. Patients were excluded if they had a history of insulin-dependent diabetes mellitus or

Patients characteristics:

All patients were men. Twelve patients had coronary artery disease and 3 had idiopathic dilated cardiomyopathy. A summary of patients’ characteristics and the electrocardiographic measurements is provided in Table 1.

Hemodynamic changes during RA pacing and RA- biventricular pacing:

Figure 1 illustrates a sample tracing of arterial blood pressure and the integrated neurogram for SNA during RA pacing and RA-biventricular pacing. RA-biventricular pacing resulted in greater arterial pressures than RA pacing (146 ± 15/83 ± 11 vs 141 ± 15/80 ± 10 mm Hg) (p <0.05).

Discussion

The main findings of this study are (1) biventricular pacing improves hemodynamics and decreases SNA compared with intrinsic conduction in patients with left ventricular dysfunction and IVCD, and (2) the decrease in SNA correlates with baseline QRS duration. To our knowledge, this is the first study to show that acute biventricular pacing decreases SNA in patients with left ventricular dysfunction and IVCD. If the current findings are true with long-term pacing, biventricular pacing may have a

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Biventricular pacing has been shown to result in hemodynamic improvement in patients with depressed ejection fraction and intraventricular conduction delay. In patients with cardiomyopathy, biventricular pacing resulted in decreased sympathetic nerve activity along with improvement in blood pressure compared with intrinsic conduction in patients with left ventricular dysfunction and intraventricular conduction delay.115 Furthermore, in 50 patients implanted with biventricular pacemakers and randomized to therapy-on (n = 25) vs therapy-off (n = 25), HRV was significantly improved in patients receiving resynchronization therapy despite a lack of difference between mean atrial cycle length.
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^☆: Dr. Hamdan was supported by Grant R01 HL-65490-01 from the National Insitutes of Health, Bethesda, Maryland.

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Effects of resynchronization therapy on sympathetic activity in patients with depressed ejection fraction and intraventricular conduction delay due to ischemic or idiopathic dilated cardiomyopathy☆

Abstract

Section snippets

Patients:

Patients characteristics:

Hemodynamic changes during RA pacing and RA- biventricular pacing:

Discussion

J Am Coll Cardiol

Multisite pacing for end-stage heart failureearly experience

Pacing Cardiac Electrophysiol

Multisite pacing as a supplemental treatment of congestive heart failurepreliminary results of the Medtronic Inc. Insync study

PACE

Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure

Circulation

Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay

Circulation