Journal of Cardiac Failure
Volume 14, Issue 1 , Pages 35-40, February 2008

Acute Electromechanical Effects of Atrioventricular Coupled Pacing in Patients With Heart Failure

  • Ronald Freudenberger, MD

      Affiliations

    • Robert Wood Johnson Medical School, New Brunswick, New Jersey
    • Corresponding Author InformationReprint requests: Ronald Freudenberger, MD, Center for Advanced Heart Failure Therapy, Lehigh Valley Hospital, 1243 S. Cedar Crest Blvd., Allentown, PA 18103.
    • ,
  • Mark Aaron, MD

      Affiliations

    • Saint Thomas Heart Institute, Nashville, Tennessee
    • ,
  • Steve Krueger, MD

      Affiliations

    • Bryan Memorial LGH, Lincoln, Nebraska
    • ,
  • Melody Labeau, BS

      Affiliations

    • Medtronic Inc, Minneapolis, Minnesota
    • ,
  • Karen Kleckner, MS

      Affiliations

    • Medtronic Inc, Minneapolis, Minnesota
    • ,
  • Ruth Nicholson Klepfer, PhD

      Affiliations

    • Medtronic Inc, Minneapolis, Minnesota

Received 17 May 2007; received in revised form 16 August 2007; accepted 4 September 2007. published online 02 November 2007.

Abstract 

Background

Postextrasystolic potentiation (PESP) is a property of cardiac tissue whereby two closely timed depolarizations cause the subsequent contraction to be of increased magnitude.

Methods and Results

Ten subjects were studied in a single-blind study to evaluate the safety and performance of an atrioventricular coupled pacing (A-VCP) algorithm to produce sustained PESP among subjects with moderate heart failure. The primary end points were algorithm safety, patient perception, and cardiac function. The effects of A-VCP on cardiac function were assessed by comparing echocardiographic parameters before and after 15 to 20 minutes of A-VCP. A-VCP produced no arrhythmic episodes, ejection fraction increased by 8 ejection fraction points (31%) (P ≤ .001), end-systolic volume decreased by 10% (P ≤ .05), and a trend toward increasing end-diastolic volume was observed (P = .084). Stroke volume increased by 43% (P ≤ .001), and the pulse rate decreased by 41% (P ≤ .001) during A-VCP. This resulted in decreased cardiac output of 15% (P ≤ .05). Six of the 10 subjects felt no effects from A-VCP, and four subjects felt a change with A-VCP turned on.

Conclusion

Short-term A-VCP was found to be safe and well tolerated in a majority of patients. Hemodynamic effects were mixed with improved ejection fraction and stroke volume but decreased cardiac output.

Key Words: Coupled pacing, Heart failure

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 This study was supported by a grant from Medtronic Inc., Minneapolis, Minnesota.

 Conflicts: Dr. Freudenberger has received grant support and is a paid consultant for Medtronic Inc. Drs. Aaron and Krueger received research support from Medtronic Inc.

 Ms. LeBeau, Ms. Kleckner, and Dr. Nicholson Klepfer are employees of Medtronic Inc.

PII: S1071-9164(07)01052-4

doi:10.1016/j.cardfail.2007.09.003

Journal of Cardiac Failure
Volume 14, Issue 1 , Pages 35-40, February 2008

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