ARTICLE: Pacemaker-induced transient asynchrony suppresses heart failure progression
AUTHORS: Kirk JA, Chakir K, Lee KH, Karst E, Holewinski RJ, Pironti G, Tunin RS, Pozios I, Abraham TP, de Tombe P, Rockman HA, Van Eyk JE, Craig R, Farazi TG, Kass DA
JOURNAL: Sci Transl Med. 2015 Dec 23;7(319):319ra207. doi: 10.1126/scitranslmed.aad2899.
Uncoordinated contraction from electromechanical delay worsens heart failure pathophysiology and prognosis, but restoring coordination with biventricular pacing, known as cardiac resynchronization therapy (CRT), improves both. However, not every patient qualifies for CRT. We show thatheart failure with synchronous contraction is improved by inducing dyssynchrony for 6 hours daily by right ventricular pacing using an intracardiac pacing device, in a process we call pacemaker-induced transient asynchrony (PITA). In dogs with heart failure induced by 6 weeks of atrial tachypacing, PITA (starting on week 3) suppressed progressive cardiac dilation as well as chamber and myocyte dysfunction. PITA enhanced β-adrenergic responsiveness in vivo and normalized it in myocytes. Myofilament calcium response declined in dogs with synchronous heart failure, which was accompanied by sarcomere disarray and generation of myofibers with severely reduced function, and these changes were absent in PITA-treated hearts. The benefits of PITA were not replicated when the same number of right ventricular paced beats was randomly distributed throughout the day, indicating that continuity of dyssynchrony exposure is necessary to trigger the beneficial biological response upon resynchronization. These results suggest that PITA could bring the benefits of CRT to the many heart failure patients with synchronous contraction who are not CRT candidates.
For a link to the full article, click here: http://stm.sciencemag.org/content/7/319/319ra207.short
Press release regarding the article: http://www.hopkinsmedicine.org/news/media/releases/unsynching_the_heartbeat_a_bit_each_day_halts_worsening_heart_failure
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