PMID- 15548885
OWN - NLM
STAT- MEDLINE
DCOM- 20050412
LR  - 20181113
IS  - 1383-875X (Print)
IS  - 1383-875X (Linking)
VI  - 11
IP  - 3
DP  - 2004 Dec
TI  - Outcome of right ventricular bifocal pacing in patients with permanent atrial 
      fibrillation and severe dilated cardiomiopathy due to Chagas disease: three years 
      of follow-up.
PG  - 193-8
AB  - OBJECTIVES OF STUDY: Several studies have shown that heart failure may benefit 
      from cardiac resynchronization therapy (CRT). Studies have demonstrated a 
      beneficial effect of right ventricular (RV) bifocal pacing, using two leads at 
      different positions, in similar patient populations. The aim was to evaluate this 
      approach in Chagas disease patients who developed both severe dilated 
      cardiomiopathy and chronic atrial fibrillation. METHODS: The study included 30 
      patients with a mean age of 52 +/- 6 years (16 male), who had atrioventricular 
      block at functional class II or IV (NYHA). Patients underwent endocardial 
      dual-chamber pacemaker implantation with two RV leads-one placed near the RV 
      outflow tract and the other in the apex. Patients were examined by 
      echocardiography, 24-hour Holter, and New York Heart Association (NYHA) class 
      determination before and 3, 6, 12, 18, 24, and 36 months after CRT. RESULTS: 
      Compared to the baseline, the left ventricular ejection fraction increased in the 
      first month of CRT, the left ventricular end diastolic diameter decreased, all 
      patients were downgraded to NYHA class I or II, and the incidence of ventricular 
      arrhythmias decreased. However, these could not be maintained and worsened after 
      6 months CRT. There was a mortality rate of 43.3% during the first year, and only 
      23.3% of patients remained alive after 3 years. They underwent an 
      electrophysiological study, which revealed complex arrhythmias justifying 
      implantable cardioverter defibrillator (ICD) in six out of seven patients. 
      CONCLUSION: The favorable effects of RV bifocal pacing could not be maintained 
      beyond the first 6 months, likely due to the ventricular arrhythmias. Therefore, 
      CRT combined with ICD from the outset may be recommended for this patient group.
FAU - da Silva Menezes, Antonio
AU  - da Silva Menezes A
AD  - Electrophysiology and Cardiac Stimulation Department, Hospital Sao Francisco de 
      Assis, Goiania, Brazil. hertz@terra.com.br cuore@pop.com.br
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - J Interv Card Electrophysiol
JT  - Journal of interventional cardiac electrophysiology : an international journal of 
      arrhythmias and pacing
JID - 9708966
SB  - IM
MH  - Atrial Fibrillation/etiology/*therapy
MH  - Cardiac Pacing, Artificial/*methods
MH  - Cardiomyopathy, Dilated/etiology/*therapy
MH  - Chagas Cardiomyopathy/*complications
MH  - Defibrillators, Implantable
MH  - Echocardiography
MH  - Electrocardiography, Ambulatory
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Right/etiology/physiopathology/therapy
EDAT- 2004/11/19 09:00
MHDA- 2005/04/13 09:00
CRDT- 2004/11/19 09:00
PHST- 2004/11/19 09:00 [pubmed]
PHST- 2005/04/13 09:00 [medline]
PHST- 2004/11/19 09:00 [entrez]
AID - 5385294 [pii]
AID - 10.1023/B:JICE.0000048569.71590.c5 [doi]
PST - ppublish
SO  - J Interv Card Electrophysiol. 2004 Dec;11(3):193-8. doi: 
      10.1023/B:JICE.0000048569.71590.c5.