Hong-Xia Niu1, Yi-Ran Hu1, Wei Hua2, Min Gu1, Jing Wang1, Michael R Gold3, Shu Zhang1. 1. State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China. 2. State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China. drhua@vip.sina.com. 3. Division of Cardiology, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC, 29425, USA. goldmr@musc.edu.
Abstract
PURPOSE: To evaluate the clinical and echocardiographic effects of prolonged cessation and resumption of left ventricular pacing among patients with chronic cardiac resynchronization therapy (CRT). METHODS: This was a retrospective analysis of patients with long-term CRT who had loss of left ventricular pacing because of battery depletion. Clinical assessment and echocardiographic data were analyzed with comparisons between implant, chronic CRT, loss of CRT, and after resumption of CRT. RESULTS: There were 7 CRT responders who underwent 8 successful pulse generator replacements due to loss of CRT 6.3 ± 2.3 months after reaching elective replacement interval. With initial CRT implantation, QRS duration decreased from 171 ± 25 to 145 ± 28 ms (P < 0.001) and left ventricular ejection fraction increased from 27.6 ± 8.1 to 53.9 ± 9.6% (P < 0.001). At pulse generator replacement, worsening heart failure was present 6 of 7 patients with significant deterioration of left ventricular function and the left ventricular ejection fraction decreased to 43.4 ± 8.4%(P = 0.001). After resumption of CRT, clinical status and cardiac function recovered with left ventricular ejection fraction increasing to 53.7 ± 8.7% (P = 0.001). CONCLUSIONS: Prolonged loss of CRT is associated with significant deterioration of left ventricular function and functional status that is fully reversible with resumption of left ventricular pacing.
PURPOSE: To evaluate the clinical and echocardiographic effects of prolonged cessation and resumption of left ventricular pacing among patients with chronic cardiac resynchronization therapy (CRT). METHODS: This was a retrospective analysis of patients with long-term CRT who had loss of left ventricular pacing because of battery depletion. Clinical assessment and echocardiographic data were analyzed with comparisons between implant, chronic CRT, loss of CRT, and after resumption of CRT. RESULTS: There were 7 CRT responders who underwent 8 successful pulse generator replacements due to loss of CRT 6.3 ± 2.3 months after reaching elective replacement interval. With initial CRT implantation, QRS duration decreased from 171 ± 25 to 145 ± 28 ms (P < 0.001) and left ventricular ejection fraction increased from 27.6 ± 8.1 to 53.9 ± 9.6% (P < 0.001). At pulse generator replacement, worsening heart failure was present 6 of 7 patients with significant deterioration of left ventricular function and the left ventricular ejection fraction decreased to 43.4 ± 8.4%(P = 0.001). After resumption of CRT, clinical status and cardiac function recovered with left ventricular ejection fraction increasing to 53.7 ± 8.7% (P = 0.001). CONCLUSIONS: Prolonged loss of CRT is associated with significant deterioration of left ventricular function and functional status that is fully reversible with resumption of left ventricular pacing.
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