Robledo NR, Buenfil MJC, Soto SJ, Zaragoza RG, Flores FJ, Sánchez PJL, Blanco CM, Juárez PN, Cortés GA

Language: Spanish
References: 24
Page: 391-398
PDF size: 362.53 Kb.

ABSTRACT

This article describes the first case in Mexico city that received a three chamber pacing system. A 40 year-old man with dilated cardiomyopathy with variant cardiac rhythm and bradycardia.The three leads were introduced by right subclavian approaches. The right chamber leads were placed in atrial’s appendage and in the right ventricular outflow tract and the last one was placed in the great cardiac vein. The two ventricular lead were connected a Y-connector to the ventricular channel of a standar bipolar DDDR pacemaker. The right ventricular lead was connected to the distal pole (anode) and the left ventricular lead to the proximal pole (cathode). Eigth days later, the patient’s clinical status improved, his functional class improved from IV to II and his left ventricular ejection fraction increased from 30% to 35% by conventional ventriculography. In this type of patients the improvement in cardiac output is this result an of increase in left ventricular filling, reduced mitral and tricuspid regurgitation a better synchronization of ventricular contraction. Multisite pacing has added a mayor complexity to contemporary pacing and a modification of the standard pacermaker code should be considered to accommodate multisite pacing. The letter in the first and second positión might be T (three) or F (four) according to number of pacing chamber and also the letter “t” may be suitable to designate trigger in the third position. We conclude that implant of three chamber pacing in patients with dilated cardiomyopathy is technically feasible. An improvement in the patient’s condition may be obtained and a modification in standard pacemaker code is necessary.

REFERENCES

1. Landzberg J, Franklin J, Mahawar S, Himelman R, Botvinick E, Schiller N, et al: Benefits of physiologic atrioventricular synchronization for pacing with an exercise rate response. Am J Cardiol 1990; 66: 193-197.

2. Hochleitner M, Hörtnagl H, Choi-Keung Ng, Hörtnagl H, Gschnitzer F, Zechmann W: Usefulness of physiologic dual-chamber pacing in drug-resistent idiopatic. Dilated Cardiomyopathy. Am J Cardiol 1990; 66: 198-202.

3. Hochleitner M, Hörtnagl H, Hörtnagl H, Fridrich L, Gschnitzer F: Long-term efficacy of physiologic dual-chamber pacingn in the treatment of end-stage idiopatic Dilated Cardiomyopathy. Am J Cardiol 1992; 70: 1320-1325.

4. Cowell R, Morris-Thurgood J, Ilsley CH, Paul V: Septal short atrioventricular delay pacing: Additional hemodynamic improvements in heart failure. PACE 1994: 17 (Pt. II): 1980-1983.

5. Buckingham T: Right ventricular outflow tract pacing. PACE 1997; 20 (Pt. I): 1237-1242.

6. Furman S, Schwedel J: An intracardiac pacemaker for Stokes-Adams seizures. N Engl J Med 1959; 261: 943-948.

7. Cazeau S, Ritter P, Bakdach S, Lazarus A, Limousin M, Henao L, et al: Four Chamber pacing in Dilated Cardiomyopathy. PACE 1994; 17 (Pt. II): 1974-1979.

8. Bai Y, Strathmore N, Mond H, Grigg L, Hunt D: Permanent ventricular pacing via the great cardiac vein. PACE 1994; 17 (Pt. I ): 678-683.

9. Daubert JC, Ritter P, Le Breton H, Gras D, Leclercq Ch, Lazarus A, et al: Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. PACE 1998; 21 (Pt. II): 239-245.

10. Shettigar UR, Loungani RR, Smith CA: Inadvertent permanent ventricular pacing from the cardiac vein: An electrocardiographic, roentgenographic and echocardiographic assessment. Clin Cardiol 1989; 12: 267-274.

11. Bernstein AD, Camm AJ, Fletcher RD, Gold RD, Rickards AF, Smyth, et al: The NASPE/BPEG generic pacemaker code for antibradyarrhythmia and adaptative-rate pacing and antitachyarrhythmia devices. PACE 1987; 10: 794-799.

12. Ritter P, Daubert C, Mabo P, Descaves C, Gouffualt J: Haemodynamic benefit of a rate-adapted A-V delay in dual chamber pacing. Eur Heart J 1989; 10: 637-646.

13. Sumiyoshi M, Nakaya Y, Tokano T, Yasuda M, Ohno Y, Hisaoka T, et al: Clinical significance of QRS duration during ventricular pacing. PACE 1992: 15: 1053-64.

14. Breker S, Xiao H, Sparrow J, Gibson D: Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet 1992; 340: 1308-12.

15. Guardigli G, Ansani L, Percoco GF, Toselli T, Spisani P, Braggion G, et al: AV delay optimization and manegement of DDD paced patients with dilated cardiomyopathy. PACE 1994; 17 (Pt. II): 1984-1988.

16. Ishikawa T, Sumita S, Kimura K, Kuji N, Nakayama R, Nagura T: Critical PQ interval for the appearance of diastolic mitral regurgitation and optimal PQ interval in patiens implanted with DDD pacemakers. PACE 1994; 17 (Pt. II): 1989-1994.

17. Nishimura R, Hayes D, Holmes D, Tajik J: Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction: An acute Doppler and catheterization hemodynamic study. J Am Coll Cardiol 1995: 25: 281-288.

18. Blanc J, Etienne Y, Gilard M, Mansourati J, Munier S, Boschat J, et al: Evaluation of different ventricular pacing sites in patients with severe heart failure. Result of an acute hemodynamic study. Circulation 1997; 96: 3273-3277.

19. Gilard M, Mansourati J, Etienne Y, Larlet J, Truong B, Boschat J, et al: Angiographic anatomy of the coronary sinus and its tributaries. PACE 1998: 21 (Pt. II): 2280-2284.

20. Moss J, Rivers J, Griffith C: Transvenous left atrial pacing for the control of recurrent ventricular fibrilation. N Engl J Med 1968; 278: 928-931.

21. Hunt D, Sloman G: Long-term eletrode catheter pacing from coronary sinus. Br Med J 1968; 4: 495-496.

22. Barold S, Cazeau S, Mugica J, Garrigue S, Clementy J: Permanent multisite cardiac pacing. PACE 1997; 20: 2725-2729.

23. Cazeau S, Ritter P, Lazarus A, Gras D, Backdach H, Mundler O, et al: Multisite pacing for end-stage heart failure: Early experience. PACE 1996; 19(Pt. II): 1748-1757.

24. Blanc J, Benditt D, Gilard M, Etienne Y, Mansourati J, Lurie K: A method for permanent tansvenous left ventricular pacing. PACE 1998; 21 (Pt. I): 2021-2024.