[Pacemaker therapy in heart failure].
Drug therapy is the standard therapy for heart failure. The current state of the art does not permit pacemaker therapy as a general recommendation for left ventricular failure. Numerous controversial reports have been published on the success of pacemaker therapies for congestive heart failure. Iskandrian reported on tachycardiac atrial stimulation in 1986. Since 1990 several papers have been published on DDD-pacemakers with short AV-time. From the data available to us, congestive heart failure is generally not considered a new pacemaker indication. In carefully selected patients, however, an improvement in hemodynamics as well as in NYHA-classification can be expected, both in acute cases and on a long-term basis. In 16 patients Hochleitner demonstrated a significant increase in left ventricular ejection fraction, a significant drop in NYHA-classification, heart size and an increase in systolic and diastolic blood pressure. Using echocardiography Brecker showed a decrease in mitral regurgitation, an increase in ventricular filling time and, by means of ergometry, a major increase in cardiac output. The hypothesis for the working mechanism is that a shorter AV-time optimizes the time needed for AV-contraction, thereby reducing mitral regurgitation, lengthening ventricular filling time and thus increasing ejection fraction. Identification of the patients to whom this hypothesis can be applied is difficult but imperative. The optimal AV-time for each patient must be established on an individual basis using echocardiography, Doppler sonography and ergometry and must be finetuned in follow-up controls. Optimization of AV-time in patients with the classic indications for a pacemaker as well as a combination of cardioverters and DDD-pacemakers should be aimed for in patients with congestive heart failure and high NYHA-classification.
Hochleitner
M
M
Medizinischen Universitätsklinik, Innsbruck.
D001283:Atrioventricular Node / Q000502:physiology; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology; D010138:Pacemaker, Artificial; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology
Schrittmachertherapie bei Herzinsuffizienz.