Cardiac Resynchronization Therapy: What Device Data Do We Need for Optimal Patient Treatment?

  • S. Sermasi
  • G. Corbucci
  • M. Marconi
  • M. Mezzetti
  • G. Piovaccari
Conference paper


The long experience of rate-responsive (RR) pacing and the technological advances in implantable devices form the basis for significant improvement of diagnostics for the treatment of atrial fibrillation (AF) or heart failure (HF) or both. In the past, the development of sensors for RR pacing gave the chance to investigate not only the effectiveness of physiological and mechanical sensors, but also long-term reliability and stability. Many sensors failed to demonstrate their long-term reliability and stability after implantation. For example, pressure sensors implanted in the right ventricle (RV) were totally surrounded by fibrosis after some months, making their membrane unreliable in detecting the true pressure. Similar problems were reported for oxygen saturation and pH sensors. Recently, pressure sensors for the RV have been proposed again for continuous monitoring of the hemodynamics of patients with HF: probably improvements in their technology have increased their long-term reliability. The strong competition for RR pacing in clinical practice has left in the market only the stable and reliable ones.


Heart Rate Variability Right Ventricle Cardiac Resynchronization Therapy Ventricular Tachyarrhythmia Implantable Device 


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  1. 1.
    Yang A, Hochhausler M, Schrickel J et al (2003) Advanced pacemaker diagnostics features in the characterization of atrial fibrillation: impact on preventive pacing algorithms. Pacing Clin Electrophysiol 26 (Part II):310–313PubMedCrossRefGoogle Scholar
  2. 2.
    Fei L, Keeling PJ, Sadoul N et al (1996) Decreased heart rate variability in patients with congestive heart failure and chronotropic incompetence. Pacing Clin Electrophysiol 19 (Part I):477–483PubMedCrossRefGoogle Scholar
  3. 3.
    Kadhiresan VA, Pastore J, Auricchio A et al (2002) A novel method-the activity log index — for monitoring physical activity of patients with heart failure. Am J Cardiol 89:1435–1437PubMedCrossRefGoogle Scholar
  4. 4.
    Diem BH, Stellbtink C, Michel M et al (2002) Temporary disturbances of the QT interval precede the onset of ventricular tachyarrhythmias in patients with structural heart diseases. Pacing Clin Electrophysiol 25:1413–1418PubMedCrossRefGoogle Scholar
  5. 5.
    Pinski SL, Eguia LE, Trohman RG (2002) What is the minimal pacing rate that prevents torsades de pointes? Insights from patients with permanent pacemakers. Pacing Clin Electrophysiol 25:1612–1615PubMedCrossRefGoogle Scholar
  6. 6.
    Medina-Ravell VA, Linkipalli RS, Yan GX et al (2003) Effect of epicardial or biventri-cular pacing to prolong QT interval and increase transmural dispersion of repolari-zation. Circulation 107:740–746PubMedCrossRefGoogle Scholar
  7. 7.
    Anderson KM, Moore AA (1986) Sensors in pacing. Pacing Clin Electrophysiol 9:954–960PubMedCrossRefGoogle Scholar
  8. 8.
    Reynolds DW, Bartelt N, Taepke R et al (1995) Measurement of pulmonary artery dia-stolic pressure from the right ventricle. J Am Coll Cardiol 25:1176–1182PubMedCrossRefGoogle Scholar
  9. 9.
    Adamson PB, Magalski A, Braunshweig F et al (2003) Ongoing right ventricle hemodynamics in heart failure. J Am Coll Cardiol 41:565–571PubMedCrossRefGoogle Scholar
  10. 10.
    Shabetai R (2003) Monitoring heart failure hemodynamics with an implanted device: its potential to improve outcome. J Am Coll Cardiol 41:572–573PubMedCrossRefGoogle Scholar
  11. 11.
    Plicchi G, Marcelli E, Parlapiano M et al (2002) PEA I and PEA II based implantable haemodynamic monitor: preclinical studies in sheep. Europace 4:49–54PubMedCrossRefGoogle Scholar
  12. 12.
    Chen D, Pibarot P, Honos G et al (1996) Estimation of pulmonary artery pressure by spectral analysis of the second heart sound. Am J Cardiol 78:785–789PubMedCrossRefGoogle Scholar
  13. 13.
    Ishikawa M, Sakata K, Maki A et al (1997) Prognostic significance of a clearly audible fourth heart sound detected a month after an acute myocardial infarction. Am J Cardiol 80:619–621PubMedCrossRefGoogle Scholar
  14. 14.
    Nohria A, Lewis E, Stevenson LW (2002) Medical management of advanced heart failure. JAMA 287:628–640PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • S. Sermasi
    • 1
  • G. Corbucci
    • 2
  • M. Marconi
    • 1
  • M. Mezzetti
    • 1
  • G. Piovaccari
    • 1
  1. 1.Dipartimento delle Malattie CardiovascolariUO di Cardiologia, Ospedale InfermiAUSL RiminiItaly
  2. 2.Vitatron ItaliaBolognaItaly

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