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European Heart Journal Advance Access originally published online on October 13, 2005
European Heart Journal 2006 27(2):187-192; doi:10.1093/eurheartj/ehi558
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Contractile response and mitral regurgitation after temporary interruption of long-term cardiac resynchronization therapy

Roland R. Brandt*, Christian Reiner, Roman Arnold, Johannes Sperzel, Heinz F. Pitschner and Christian W. Hamm

Division of Cardiology, Kerckhoff Heart Center, Benekestr 2–8, 61231 Bad Nauheim, Germany

Received 17 March 2005; revised 24 August 2005; accepted 8 September 2005; online publish-ahead-of-print 13 October 2005.

* Corresponding author. Tel: +49 6032 996 0; fax: +49 6032 996 2227. E-mail address: r.brandt{at}kerckhoff-klinik.de

Aims Cardiac resynchronization therapy (CRT) utilizing biventricular pacing (BVP) is a promising treatment modality for symptomatic patients with chronic left ventricular (LV) systolic dysfunction and intraventricular conduction delay. Clinical studies have shown short-term improvement in contractile function and mid-term improvement in clinical status with CRT. The objective of this study was to evaluate the haemodynamic consequences of temporary interruption of CRT after long-term stimulation.

Methods and results Twenty patients (16 men, 4 women) with LV dysfunction and New York Heart Association class III or IV heart failure, despite optimal medical therapy and a QRS interval of at least 120 ms, received a transvenous BVP system at the age of 66 (interquartile range, 61–69). Patients were studied after a median duration of 427 days (interquartile range, 281–563) of continuous CRT and again 72 h after cessation of BVP. Withdrawal of CRT resulted in a significant decline in maximal rate of LV systolic pressure rise from 711 mmHg/s (interquartile range, 640–816) to 442 mmHg/s (interquartile range, 389–582) (P=0.0001) and increases in mitral effective regurgitant orifice area from 4.8 mm2 (interquartile range, 0.0–7.8) to 9.1 mm2 (interquartile range, 5.7–13.3) (P=0.0001), mitral regurgitant volume from 7.8 mL (interquartile range, 0.0–11.5) to 16.0 mL (interquartile range, 10.7–20.8) (P=0.0001) and fraction from 13.8% (interquartile range, 0.0–19.2) to 27.7% (interquartile range, 14.6–34.0) (P=0.0002) determined by Doppler echocardiography.

Conclusion Cessation of long-term BVP leads to a decline in LV systolic performance and an increase in functional mitral regurgitation. These results indicate a sustained benefit of long-term CRT and support the notion to maintain CRT indefinitely.

Key Words: Cardiac resynchronization therapy • Contractility • Heart failure • Mitral regurgitation


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