Physiology of biventricular pacing

被引：20

作者：

Bilchick K.C. ^{[1
]}

Helm R.H. ^{[1
]}

Kass D.A. ^{[1
]}

机构：

[1] Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD 21205

来源：

Current Cardiology Reports | 2007年 / 9卷 / 5期

关键词：

Right Ventricular; Cardiac Resynchronization Therapy; Mechanical Dyssynchrony; Biventricular Pace; Leave Ventricular Lead;

D O I：

10.1007/BF02938362

中图分类号：

学科分类号：

摘要：

Biventricular pacing (cardiac resynchronization therapy [CRT]) has been shown to be a very effective therapy for patients with heart failure and dyssynchrony, with improved survival now shown in a recent trial. Electrical dyssynchrony, usually quantified by the duration of the QRS complex, is distinct from mechanical dyssynchrony. Intraventricular mechanical dyssynchrony is most commonly manifest by decreased septal work with concomitant early lateral wall prestretch and subsequent inefficient late contraction. Intraventricular dyssynchrony appears to be more predictive of response to CRT than interventricular dyssynchrony. Mechanical left ventricular dyssynchrony also is associated with regional molecular derangements in connexin-43, stress response kinases, and tumor necrosis factor-α. These molecular derangements may lead to abnormalities in conduction velocity and action potential duration, which may predispose to ventricular arrhythmia. Biventricular pacing corrects abnormal regional wall stresses and results in electrical, mechanical, and molecular left ventricular remodeling. Copyright © 2007 by Current Medicine Group LLC.

引用

页码：358 / 365

页数：7

共 50 条

[1]

Roger V.L., Weston S.A., Redfield M.M., Et al., Trends in heart failure incidence and survival in a community-based population, JAMA, 292, pp. 344-350, (2004)

[2]

Levy D., Kenchaiah S., Larson M.G., Et al., Long-term trends in the incidence of and survival with heart failure, N Engl J Med, 347, pp. 1397-1402, (2002)

[3]

Haldeman G.A., Croft J.B., Giles W.H., Et al., Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995, Am Heart J, 137, pp. 352-360, (1999)

[4]

Ho K.K., Pinsky J.L., Kannel W.B., Et al., The epidemiology of heart failure: The Framingham Study, J Am Coll Cardiol, 22, (1993)

[5]

Shamim W., Francis D.P., Yousufuddin M., Et al., Intraventricular conduction delay: A prognostic marker in chronic heart failure, Int J Cardiol, 70, pp. 171-178, (1999)

[6]

Baldasseroni S., Opasich C., Gorini M., Et al., Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: A report from the Italian network on congestive heart failure, Am Heart J, 143, pp. 398-405, (2002)

[7]

Bristow M.R., Saxon L.A., Boehmer J., Et al., Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure, N Engl J Med, 350, pp. 2140-2150, (2004)

[8]

Cleland J.G., Daubert J.C., Erdmann E., Et al., The effect of cardiac resynchronizatiun on morbidity and mortality in heart failure, N Engl J Med, 352, pp. 1539-1549, (2005)

[9]

Durrer D., van Dam R.T., Freud G.E., Et al., Total excitation of the isolated human heart, Circulation, 41, pp. 899-912, (1970)

[10]

Spragg D.D., Akar F.G., Helm R.H., Et al., Abnormal conduction and repolarization in late-activated myocardium of dyssynchronously contracting hearts, Cardiovasc Res, 67, pp. 77-86, (2005)

← 1 2 3 4 5 →