Response to Cardiac Resynchronization Therapy of Previously Right Ventricular Paced Heart Failure Patients
| Status: | Completed |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | October 2011 |
| End Date: | June 2014 |
The present proposal is designed to investigate the response to CRT in patients who were
previously paced from the right ventricle (RV). The negative physiologic and structural
changes associated with chronic RV pacing are well documented, but patient response
following upgrade to CRT after chronic RV pacing has not been well characterized in a large
cohort.
previously paced from the right ventricle (RV). The negative physiologic and structural
changes associated with chronic RV pacing are well documented, but patient response
following upgrade to CRT after chronic RV pacing has not been well characterized in a large
cohort.
The RV apex has historically been used as the site for ventricular pacing in cases of sinus
node dysfunction or atrioventricular block because of its relatively accessible location for
lead implantation. Initial studies showed RV pacing improved symptoms, exercise capacity,
quality of life, and survival in these patients.11-13 However, more recent studies have
illustrated that chronic RV pacing may actually impair LV systolic function and increase the
risks of heart failure, hospitalization, and death in some patients.
The primary hypothesis is that patients upgraded to CRT from a RV pacemaker respond better
than those receiving CRT as a first time device. To test this hypothesis the investigators
will compare changes in cardiac size and function, and hospitalization and survival rates
between the two patient groups.
The second hypothesis will investigate whether changes in septal dyssynchrony are correlated
with changes in ejection fraction in previously RV paced patients. The investigators believe
that the patients with the most improvement in septal dyssynchrony due to RV pacing will see
the greatest improvement in LV function following upgrade to CRT. A significant correlation
between change in IM-S and change in EF will support the hypothesis.
node dysfunction or atrioventricular block because of its relatively accessible location for
lead implantation. Initial studies showed RV pacing improved symptoms, exercise capacity,
quality of life, and survival in these patients.11-13 However, more recent studies have
illustrated that chronic RV pacing may actually impair LV systolic function and increase the
risks of heart failure, hospitalization, and death in some patients.
The primary hypothesis is that patients upgraded to CRT from a RV pacemaker respond better
than those receiving CRT as a first time device. To test this hypothesis the investigators
will compare changes in cardiac size and function, and hospitalization and survival rates
between the two patient groups.
The second hypothesis will investigate whether changes in septal dyssynchrony are correlated
with changes in ejection fraction in previously RV paced patients. The investigators believe
that the patients with the most improvement in septal dyssynchrony due to RV pacing will see
the greatest improvement in LV function following upgrade to CRT. A significant correlation
between change in IM-S and change in EF will support the hypothesis.
Inclusion Criteria:
- Received a CRT device between 2003 and 2009 at United Heart & Vascular Clinic
- QRS duration > 120 msec
- Pre-CRT ejection fraction =< 35%
Exclusion Criteria:
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