[CRT-FORUM] 16S. Right bundle branch block and CRT. Dr. Schapachnik

[CRT-INFO]

Dear colleagues,
The prior message by Dr. Levine was accompanied by two attached files that
illustrated his text. For some technical reason, the files were not
distributed.
Those of you that wish to receive them, may pick them up over the next five
days at the following address:

http://www.grupoakros.com.ar/upload/files/0093303100/Single_Lead_Cardiac_Resynchronization_in_the_Presence_of_RBBB.pdf

http://www.grupoakros.com.ar/upload/files/7098303903/01080809.doc

Best regards,

Edgardo
> Dr. Perez makes some excellent points.  I would like to cite a 
> reference with respect to VERBS - Ventricular Endocardial Right 
> Bifocal Stimulation.  Dr. Jose Pachon and colleagues have a superb 
> article reviewing this topic published in 2001.
> Pachon J C, et al, Ventricular Endocardial Right Bifocal Stimulation 
> in the treatment of severe dilated cardiomyopathy heart failure with 
> wide QRS, PACE 2001; 24: 1369-1376
>
> If either Dr. Juan, Enrique or Jose Pachon are participating in this 
> symposium, perhaps they might offer some additional comments with 
> respect to VERBS and its potential role in the treatment of Chagasic 
> cardiomyopathy.
>
> With respect to RBBB, over the years, I have treated a number of 
> patients for sick sinus syndrome who have concomitant RBBB and have 
> normalized the QRS complex by careful programming of the paced and 
> sensed AV delays to force intentional fusion.   This has not been 
> subjected to formal clinical study and in the patients in whom I have 
> used this technique, their ventricular function was basically normal.   
> The concept of using fusion to improve hemodynamics was first reported 
> (that I am aware of) at the VIIth World Symposium on Cardiac Pacing in 
> 1983 in Vienna by de Teresa and colleagues.  They studied 4 patients 
> with chronic LBBB who had undergone aortic valve surgery.  They were 
> doing poorly in the post-operative period and taking advantage of 
> temporary LV epicardial pacing lead and insertion of a temporary 
> endocardial right atrial lead, they carefully timed ventricular pacing 
> (LV lead pacing) with the P wave and intrinsic conduction to result in 
> fusion with normalization of the QRS and improvement in hemodynamics.   
>
>
> Paul A. Levine MD, FHRS, FACC, CCDS
> Vice President, Medical Services
> St, Jude Medical CRMD
> Tel: 1-818-493-2900 Fax: 1-818-362-2242
> plevine at sjm.com
> Clinical Professor of Medicine - Loma Linda University School of Medicine
> Clinical Associate Professor of Medicine -UCLA


-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee


-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee