title: Permanent left atrial pacing therapy may improve symptoms in heart failure patients with preserved ejection fraction and atrial dyssynchrony: a pilot study prior to a national clinical research programme.
abstract: OBJECTIVE
  Our group has recently shown that in some patients, heart failure with preserved ejection fraction (HFPEF) may be explained by 'atrial dyssynchrony syndrome' (ADS) due to interatrial conduction delay (IACD), a short left atrioventricular interval (LAVI), and increased left atrial (LA) stiffness. Our primary objective was to evaluate LA pacing therapy as a new treatment to restore left ventricular active filling in patients with no other known causes for HF than ADS.
  
  
  RESULTS
  Six patients with severe HFPEF with IACD (P wave duration >120 ms in lead II), short LAVI during electrophysiological studies (<70 ms), a restrictive filling pattern (E/e' >15), and no standard indication for a pacemaker were implanted with a lead screwed inside the coronary sinus for active LA pacing. After 3 months of active pacing, a 2 week randomized double-blind crossover phase compared active vs. inactive LA pacing. After 3 months of pacing, the mean distance walked in 6 min (6MWD) was 21% greater (240 ± 25 m vs. 190 ± 15m, P < 0.05), mitral A wave duration was longer (104 ± 8 vs. 158 ± 25 ms, P = 0.002), and E/A and E/e' ratios were smaller (3.4 ± 1.3 vs. 1.8 ± 0.9, P = 0.009, and 22.6 ± 4.6 vs. 15.3 ± 4.3, P = 0.006, respectively). Inactivation of pacing for 1 week led to a significant reduction in the 6MWD, with an on/off response.
  
  
  CONCLUSIONS
  The beneficial effects of LA pacing observed in this pilot study will have to be confirmed by the randomized, controlled crossover 'LEAD' study.
authors.affiliation: University Bocage Hospital, Dijon, Burgundy, France. gabriel.laurent@chu-dijon.fr
authors.forename: Gabriel
authors.initials: G
authors.lastname: Laurent
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Eicher
authors.forename: Anaëlle
authors.initials: A
authors.lastname: Mathe
authors.forename: Géraldine
authors.initials: G
authors.lastname: Bertaux
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthez
authors.forename: Régine
authors.initials: R
authors.lastname: Debin
authors.forename: Clotilde
authors.initials: C
authors.lastname: Billard
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Philip
authors.forename: Jean Eric
authors.initials: JE
authors.lastname: Wolf
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D005602:France; D006325:Heart Atria / Q000503:physiopathology*; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome