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Eur J Cardiothorac Surg 2006;29:634
© 2006 Elsevier Science NL

Letter to the Editor

Reply to Fernández et al.

Michael J. Flynn * , Janet M. McComb, John H. Dark

Department of Cardiac Surgery and Cardiology, Freeman Hospital, Newcastle-on-Tyne NE3 1DE, UK

Received 22 December 2005; accepted 23 December 2005.

* Corresponding author. Tel.: +44 191 2843313; fax: +44 191 2226587. (Email: barradrum{at}hotmail.com).

Key Words: Temporary pacing • Left ventricular pacing • Biventricular pacing

It is a pleasure to reply to the constructive comments of Dr Fernández and co-authors, which highlight current problems in cardiac electrophysiology. The term cardiac re-synchronisation therapy (CRT) is increasingly utilised to define attempts at modification of cardiac electro-pathophysiology or aberrant conduction in order to improve haemodynamic performance. As indicated by Rosanio et al. [1], the exact indications for CRT, as well as technical application problems continue to pioneer groups in electrophysiology.

The aim of our study was to investigate the effects of LV pacing on haemodynamic performance compared to the standard practice of RV pacing. The origins of this study evolved from the evidence that much of the haemodynamic benefit of biventricular pacing is derived from the effects of pacing on LV function [2]. Our relatively small study demonstrated that with active lead placement on the LV lateral wall, i.e., posteriorly, a significant improvement in haemodynamics was achieved. Specific to Fernández and co-authors’ nomenclature criticism regarding split biventricular pacing versus LV pacing, this demonstrates a limitation in current definitions.

Similarly, we agree that some authors would have defined our method of LV pacing as biventricular pacing. Recent surgical studies have described separate active lead placement on both the RV and the LV [3,4]. We accept this author's suggestion regarding alternate placement of the inactive lead. However, this questions the implications of the site of inactive lead placement, which is also a matter of debate.

Undoubtedly, the possible benefits of CRT upon myocardial dysfunction remain undefined. However, beneath the broad title of CRT, specific definitions of biventricular pacing and LV pacing are now required. Finally, we sincerely thank Dr Fernández and co-authors for this excellent contribution.

References

  1. Rosanio S, Schwarz ER, Ahmad M, Jammula P, Vitarelli A, Uretsky BF, Birnbaum Y, Ware DL, Atar S, Saeed M. Benefits, unresolved questions and technical issues of cardiac resynchronization therapy for heart failure. Am J Cardiol 2005;96(5):710-717.[CrossRef][Medline]
  2. Touiza A, Etienne Y, Gilard M, Fatemi M, Mansourati J, Blanc J. Long-term left ventricular pacing: assessment and comparison with biventricular pacing in patients with severe congestive heart failure. J Am Coll Cardiol 2001;38:1966-1970.[Abstract/Free Full Text]
  3. Berberian G, Quinn TA, Kanter JA, Curtis LJ, Carberiza SE, Weinberg AD, Spotnitz HM. Optimized biventricular pacing in atrio-ventricular block after cardiac surgery. Ann Thorac Surg 2005;80(3):870-875.[Abstract/Free Full Text]
  4. Kurzidim R, Reinke H, Sperzel J, Schreider HJ, Danilovic D, Siemon G, Neumann T, Hamm CW, Pitscher HF. Invasive optimization of cardiac re-synchronization therapy: role of sequential biventricular and left ventricular pacing. Pacing Clin Electrophysiol 2005;28(8):754-761.[CrossRef][Medline]




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