Long-term effects of upgrading to biventricular pacing: differences with cardiac resynchronization therapy as primary indication.

Background: Few studies have assessed the long-term effects of cardiac resynchronization therapy (CRT) in patients with advanced heart failure (HF) and previously right ventricular apical pacing (RVAP).

Aims: To assess the clinical and hemodynamic impact of upgrading to biventricular pacing in patients with severe HF and permanent RVAP in comparison with patients who had CRT implantation as initial therapy.

Methods And Results: Thirty-nine patients with RVAP, advanced HF (New York Heart Association [NYHA] III-IV), and severe depression of left ventricular ejection fraction (LVEF) were upgraded to biventricular pacing (group A).

Variability of left ventricular electromechanical activation during right ventricular pacing: implications for the selection of the optimal pacing site.

Background: The right ventricular septum (RVS) and Hisian area (HA) are considered more "physiological" pacing sites than right ventricular apex (RVA). Studies comparing RVS to RVA sites have produced controversial results. There are no data about variability of electromechanical activation obtained by an approach using fluoroscopy and electrophysiological markers.

Left ventricular dyssynchrony resulting from right ventricular apical pacing: relevance of baseline assessment.

Objectives: Evaluation of left ventricular (LV) dyssynchrony in patients undergoing short-term right ventricular apical (RVA) pacing and correlation with baseline echocardiographic and clinical characteristics.

Background: RVA pacing causes abnormal ventricular depolarization that may lead to mechanical LV dyssynchrony. The relationships between pacing-induced LV dyssynchrony and baseline echocardiographic and clinical variables have not been fully clarified.

Persistent left superior vena cava in patients treated with His-bundle pacing: trouble or help?

We describe a case of a 50-year-old man with advanced atrioventricular block treated successfully with His-bundle pacing via a persistent left superior vena cava draining into the coronary sinus.

Neurocardiogenic syncope: a case of prolonged asystole.

We report the case of a 48-year-old woman with frequent episodes of loss of consciousness. The patient was submitted to head-up tilt testing that evoked a prolonged asystole associated with sphincteric incontinence and loss of urine. The patient was treated with dual-chamber pacemaker implantation; at a follow-up of 18 months no other episodes of syncope had occurred.