Chronic right ventricular pacing, adverse remodelling, and CRT: an ounce of prevention?

Content Provider	Semantic Scholar
Author	Dickstein, Kenneth
Copyright Year	2011
Abstract	This commentary refers to ‘Biventricular pacing is superior to right ventricular pacing in bradycardia patients with preserved systolic function: 2-year results of the PACE trial’[†][1], by J.Y.-S. Chan et al. , on page 2533 In medicine, it is encouraging when research yields results consistent with our understanding of the operative mechanisms, especially when there is a direct potential impact on clinical practice. Chan et al . have provided us with such a result and a clear message.1 The 2-year follow-up in the Pacing to Avoid Cardiac Enlargement (PACE) trial confirms that chronic right ventricular (RV) pacing in patients with bradycardia and preserved left ventricular (LV) function leads to sustained and progressive deterioration of LV ejection fraction (EF) and increases in LV volumes. This adverse remodelling process was prevented by pacing with cardiac resynchronization therapy (CRT). Adverse LV remodelling is a complex maladaptive process involving structural, haemodynamic, histopathological, and genetic changes.2 The process may be multifactorial and is frequently encountered in patients after loss of myocardium (myocardial infarction), volume overload (valvular insufficiency), or pressure overload (hypertension). It involves both LV hypertrophy and dilatation, and is initially an adaptive response that serves to maintain stroke volume. If persistent and progressive, the process becomes maladaptive and leads to further deterioration of LV function, LV dilatation, and eventually the typical symptoms of heart failure (HF). It is evident that substantial prolongation of the QRS interval, especially with a left bundle branch pattern, results in a delayed and dyssynchonous LV contraction.3 This dyssynchrony may be a major contributor that can both initiate and aggravate the process of adverse remodelling. In patients with symptomatic HF, systolic … [1]: #fn-2
Starting Page	157
Ending Page	181
Page Count	25
File Format	PDF HTM / HTML
Alternate Webpage(s)	https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/eurheartj/32/20/10.1093/eurheartj/ehr337/2/ehr337.pdf?Expires=1492064223&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q&Signature=Dl8sRzqGYDjf9t~Zox5eR9Rs75gx1PJ2Z94MHcQV6HkwNd32jwCJYgdyy9EXu54t1F1gsZfIakCsGb1i3kMhXdP42rqKFE-LOP2GbDB0WsA6AJarxX-px3LAuhOIiur1axS8hD8gbWC7GGdf9CSKJPP6CVmlDDhezN00lVXTMMoxaQEr0~EyN6KUpAFdMPw-vEmqvtTph9hl67iyxBnE7SyPL642TL-O93L4fJfxiIKi-z0ZeGwkAqxWQrHL26neUhFVw27tJduwXdQ6RpOaBdHRFqBjI4lxqM2xqQ40q0juPJ7MWOeuZHhS0DV77gvMlVXR3QlXFGFyRv2jPihCrg__
PubMed reference number	21875861v1
Alternate Webpage(s)	https://doi.org/10.1093/eurheartj/ehr337
DOI	10.1093/eurheartj/ehr337
Journal	European heart journal
Volume Number	32
Issue Number	20
Language	English
Access Restriction	Open
Subject Keyword	Artificial cardiac pacemaker Biologic Preservation Blinded Bradycardia Cardiac Resynchronization Therapy Cerebrovascular accident Dilate procedure Echocardiography Echocardiography, Three-Dimensional Ejection fraction (procedure) End Systolic Volume Imaging Fluid overload Follow-Up Report Heart Diseases Heart failure Heart valve disease Hypertensive disease Hypertrophy Kidney Failure, Chronic Left bundle branch structure Left ventricular ejection fraction Morbidity - disease rate Myocardial Infarction Myocardium Patients Scientific Publication Stroke Volume Ventricular Dysfunction, Left Ventricular Fibrillation ounce
Content Type	Text
Resource Type	Article