FEASIBILITY AND EFFICACY OF LEFT ATRIAL PACING IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION ASSOCIATED WITH ATRIAL DYSSYNCHRONY | XXII. výroční sjezd České kardiologické společnosti

Background. Heart failure with preserved ejection fraction (HFPEF) remains an unsolved problem, as no pharmacological treatment has been able to improve outcomes so far. Our group has recently shown that in some patients HFPEF may be explained by an ‘atrial dyssynchrony syndrome’ (ADS) due to interatrial conduction delay (IACD), a short left atrioventricular interval (LAVI), and increased left atrial (LA) stiffness. Our primary objective was to evaluate LA pacing therapy as a new treatment to restore left ventricular active filling in patients with no other known causes for HF than ADS. Methods and results Six patients with severe HFPEF with IACD (P wave duration >120 ms in lead II), short LAVI during electrophysiological studies (<70 ms), a restrictive filling pattern (E/e’ >15), and no standard indication for a pacemaker were implanted with a lead screwed inside the coronary sinus for active LA pacing. After 3 months of active pacing, a 2 week randomized double-blind crossover phase compared active vs. inactive LA pacing. After 3 months of pacing, the mean distance walked in 6 min (6MWD) was 21% greater (240+25 m vs. 190+15m, P <0.05), mitral A wave duration was longer (104+8 vs. 158+25 ms, P = 0.002), and E/A and E/e’ ratios were smaller (3.4+1.3 vs. 1.8+0.9, P= 0.009, and 22.6+4.6 vs. 15.3+4.3, P= 0.006, respectively). Inactivation of pacing for 1 week led to a significant reduction in the 6MWD, with an on/off response. Conclusion. In patients with HFPEF associated with interatrial dyssynchrony, left atrial pacing via the coronary sinus is feasible and results in significant improvement of symptoms and left ventricle filling pattern.

FEASIBILITY AND EFFICACY OF LEFT ATRIAL PACING IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION ASSOCIATED WITH ATRIAL DYSSYNCHRONY Tématický okruh: Rehabilitace v kardiologii
Typ: Ústní sdělení - lékařské , Číslo v programu: 452
Sdělení navržené do bloku Asociace/PS/OS: PS Kardiovaskulární rehabilitace

Eicher J.¹, Laurent G.², Mathé A.¹, Bertaux G.¹, Guenancia C.², Wolf J.¹, Dobšák P.³, Siegelová J.⁴ ¹ Cardiology Department, Burgundská Univerzita, Dijon, France, ² Dijon, ³ Klinika funkční diagnostiky a rahabilitace LF MU, FN u sv. Anny, Brno, ⁴ Klinika funkční diagnostiky a rehabilitace LF MU, FN u sv. Anny, Brno
Background. Heart failure with preserved ejection fraction (HFPEF) remains an unsolved problem, as no pharmacological treatment has been able to improve outcomes so far. Our group has recently shown that in some patients HFPEF may be explained by an ‘atrial dyssynchrony syndrome’ (ADS) due to interatrial conduction delay (IACD), a short left atrioventricular interval (LAVI), and increased left atrial (LA) stiffness. Our primary objective was to evaluate LA pacing therapy as a new treatment to restore left ventricular active filling in patients with no other known causes for HF than ADS. Methods and results Six patients with severe HFPEF with IACD (P wave duration >120 ms in lead II), short LAVI during electrophysiological studies (<70 ms), a restrictive filling pattern (E/e’ >15), and no standard indication for a pacemaker were implanted with a lead screwed inside the coronary sinus for active LA pacing. After 3 months of active pacing, a 2 week randomized double-blind crossover phase compared active vs. inactive LA pacing. After 3 months of pacing, the mean distance walked in 6 min (6MWD) was 21% greater (240+25 m vs. 190+15m, P <0.05), mitral A wave duration was longer (104+8 vs. 158+25 ms, P = 0.002), and E/A and E/e’ ratios were smaller (3.4+1.3 vs. 1.8+0.9, P= 0.009, and 22.6+4.6 vs. 15.3+4.3, P= 0.006, respectively). Inactivation of pacing for 1 week led to a significant reduction in the 6MWD, with an on/off response. Conclusion. In patients with HFPEF associated with interatrial dyssynchrony, left atrial pacing via the coronary sinus is feasible and results in significant improvement of symptoms and left ventricle filling pattern.

PROHLÍŽENÍ ABSTRAKTA