L'elettrostimolazione cardiaca bicamerale nella cardiomiopatia dilatativa in III-IV classe funzionale NYHA

valutazione clinico-strumentale a breve e medio termine.

Translated title of the contribution: Dual-chamber DDD pacing in NYHA III-IV functional class dilated cardiomyopathy: short and middle-term evaluation

E. Occhetta, M. Bortnik, G. Francalacci, G. Sarasso, C. Piccinino, M. Pistono, B. Marenna, P. Paffoni, M. Sacchetti, E. Inglese, G. Trevi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Effectiveness of dual-chamber pacing in patients with dilated cardiomyopathy is still controversial. Our study was performed: to select the most favorable individual atrioventricular (AV) delay; to compare hemodynamic short-term effects in each patient after 2 periods of DDD pacing and sinus rhythm (AV spontaneous); to assess hemodynamic long-term (1 year) effects after DDD pacing at optimum AV delay. In 1996, 9 patients (7 men, 2 women; mean age 69 +/- 5 years) with dilated cardiomyopathy (5 idiopathic, 4 ischemic), NYHA functional class III-IV, ejection fraction <30%, end-diastolic volume > 60 ml/m2, mitral regurgitation +2/+3, PR interval > or = 200 ms, were enrolled. All patients were implanted with DDD pacemakers and monitored for: ejection fraction and end-diastolic volume (measured by echocardiography and radionuclide angiography); clinical conditions; exercise tolerance and maximum oxygen consumption (by Weber exercise protocol); neurohormonal activity (plasma renin, aldosterone, atrial natriuretic factor). Data were recorded: before DDD implantation; after 2 randomized, single-blind periods of 3 months in VVI mode (at ventricular "sentinel" rate of 50 b/min) and in DDD mode with the optimum AV delay, corresponding for each patient to the minimum end-diastolic volume measured by radionuclide angiography and to the highest cardiac output recorded by echocardiography; after 6 months of DDD pacing with most favorable AV delay. Three more patients died 6 months after (between sixth and twelfth month of follow-up), due to refractory heart failure; 1 patient dropped out because his pacemaker was programmed in VVI mode at low rate, due to intolerance of DDD pacing. Among the other 4 patients no clinical and laboratory parameters were significantly different after 1 year of follow-up. In conclusion, DDD pacing in selected patients with dilated cardiomyopathy showed disappointing results, despite a strict and laboratory monitoring; DDD pacing could be of major benefit in larger populations, according to Doppler mitral flow pattern: those patients with a larger A-wave amplitude could be more sensitive to DDD pacing than those with evidence of poor atrial systole. Moreover, biatral and/or biventricular pacing could also play a significant role.

Original languageItalian
Pages (from-to)1327-1335
Number of pages9
JournalCardiologia
Volume43
Issue number12
Publication statusPublished - Dec 1998

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Dichlorodiphenyldichloroethane
Dilated Cardiomyopathy
Radionuclide Angiography
Echocardiography
Hemodynamics
High Cardiac Output
Cardiac Resynchronization Therapy
Exercise Tolerance
Systole
Mitral Valve Insufficiency
Atrial Natriuretic Factor
Aldosterone
Renin
Oxygen Consumption
Heart Failure
Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

L'elettrostimolazione cardiaca bicamerale nella cardiomiopatia dilatativa in III-IV classe funzionale NYHA : valutazione clinico-strumentale a breve e medio termine. / Occhetta, E.; Bortnik, M.; Francalacci, G.; Sarasso, G.; Piccinino, C.; Pistono, M.; Marenna, B.; Paffoni, P.; Sacchetti, M.; Inglese, E.; Trevi, G.

In: Cardiologia, Vol. 43, No. 12, 12.1998, p. 1327-1335.

Research output: Contribution to journalArticle

Occhetta, E, Bortnik, M, Francalacci, G, Sarasso, G, Piccinino, C, Pistono, M, Marenna, B, Paffoni, P, Sacchetti, M, Inglese, E & Trevi, G 1998, 'L'elettrostimolazione cardiaca bicamerale nella cardiomiopatia dilatativa in III-IV classe funzionale NYHA: valutazione clinico-strumentale a breve e medio termine.', Cardiologia, vol. 43, no. 12, pp. 1327-1335.
Occhetta, E. ; Bortnik, M. ; Francalacci, G. ; Sarasso, G. ; Piccinino, C. ; Pistono, M. ; Marenna, B. ; Paffoni, P. ; Sacchetti, M. ; Inglese, E. ; Trevi, G. / L'elettrostimolazione cardiaca bicamerale nella cardiomiopatia dilatativa in III-IV classe funzionale NYHA : valutazione clinico-strumentale a breve e medio termine. In: Cardiologia. 1998 ; Vol. 43, No. 12. pp. 1327-1335.
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