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Improved cardiac performance through pacing-induced diaphragmatic stimulation : a novel electrophysiological approach in heart failure management?

Roos, Markus and Kobza, Richard and Jamshidi, Peiman and Bauer, Peter and Resink, Thérèse and Schlaepfer, Reinhard and Stulz, Peter and Zuber, Michel and Erne, Paul. (2009) Improved cardiac performance through pacing-induced diaphragmatic stimulation : a novel electrophysiological approach in heart failure management? Europace : European pacing, arrythmias and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 11. pp. 191-199.

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Official URL: http://edoc.unibas.ch/dok/A6006170

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Abstract

AIMS: Pharmacological conditioning of the phrenic nerve can positively influence systolic performance, and diaphragm activation improves ventilatory function. Here we investigate whether pacing-induced diaphragmatic stimulation (PIDS) may improve left ventricular (LV) systolic function. METHODS AND RESULTS: We studied a total of 35 patients (4 females, mean age 67 +/- 9 years, ejection fraction 61 +/- 14%) within 7 days following open heart surgery. The haemodynamic impact of different PIDS and ventricular pacing configurations and coupling intervals was tested in 132 episodes. Success of PIDS was assessed using fluoroscopy and palpation. Left ventricular systolic performance was recorded using the electromechanical activation time (EMAT) obtained through acoustic cardiography. Eighteen subjects were tested in the catheter laboratory and 17 in the intensive care unit. For both groups, EMAT significantly improved when the diaphragm was stimulated 20 ms after the onset of ventricular pacing. In all instances, PIDS could be induced with or without causing patient symptoms, and LV systolic performance improvement was comparable in symptomatic and asymptomatic modes. No desensitization of the diaphragm was observed following PIDS delivery 4-6 and 24 h following open heart surgery. CONCLUSION: Pacing-induced diaphragmatic stimulation, if synchronized to the onset of ventricular contraction with a fixed, non-zero coupling delay, can improve LV systolic function reproducibly for at least 1 h without causing patient symptoms. The absence of diaphragm desensitization further underscores the potential of PIDS as a practical therapeutic approach in device-based heart failure management.
Faculties and Departments:03 Faculty of Medicine > Departement Biomedizin > Further Research Groups at DBM > Signal Transduction (Resink/Erne)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie
UniBasel Contributors:Resink, Thérèse J. and Zuber, Michel
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Oxford University Press
ISSN:1099-5129
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:24 May 2013 09:21
Deposited On:24 May 2013 09:02

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