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RV Function in Stable and Unstable VT: Is There a Need for Hemodynamic Monitoring in Future Defibrillators?
Author(s) -
HEGBOM FINN,
HOFF PER I.,
ØIE BERTIL,
FØLLING MAGNE,
ZEIJLEMAKER VOLKERT,
LINDEMANS FRED,
OHM OLEJØRGEN
Publication year - 2001
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2001.00172.x
Subject(s) - medicine , cardiology , pulse pressure , hemodynamics , mean arterial pressure , ventricular pressure , blood pressure , heart rate
HEGBOM, F., et al. : RV Function in Stable and Unstable VT: Is There a Need for Hemodynamic Monitoring in Future Defibrillators? During electrophysiological investigation of 22 patients with VT or aborted sudden cardiac death, arterial and RV pressures were measured. The time courses of mean arterial pressure (MAP), RV pulse pressure (RVPP), RV pulse pressure integral (RVPPI), and maximum right ventricular dP/dt (RV dP/dt max ) were followed during the first 15 seconds after VT induction. Compared to basal (preinduction) conditions, the RVPPI decreased by 41 ± 10% ( mean ± SD ) after 10–15 seconds of VT in 11 patients with stable VT and by 75 ± 8% in 11 patients with unstable VT ( MAP < 60 mmHg 15 s after VT onset ). RVPP decreased by 13 ± 11% after 10–15 seconds of VT in the stable VT group and by 50 ± 16% in the unstable VT group. For RV dP/dt max , these decreases were 4 ± 22% in the stable VT group and 37 ± 24% in the unstable VT group. There was a good correlation between percent decrease in MAP and percent decrease in RVPPI, RVPP, and RV dP/dt max at 5–10 seconds ( r = 0.86, 0.81, and 0.73, respectively ) and 10–15 seconds ( r = 0.84, 0.82, and 0.69, respectively ) after VT onset. There was hardly any overlap of distributions of the individual values with the RVPPI parameter between the two VT groups. Comparing and correlating the percent decrease in mean arterial pressure with the RVPPI, RVPP, and RV dP/dt max during induced VT, RVPPI demonstrated the most significant and specific changes in discriminating stable from unstable rhythms. However, by comparing RVPPI and RVPP using the area under the receiver operating characteristic curves, there was no significant statistical difference between the two parameters. By integrating rate criteria, electrogram signal analysis, and RVPPI or RVPP as a hemodynamic criterion, detection and treatment algorithms could improve the performance of future implantable defibrillators and avoiding shocks in VTs that can be terminated by antitachycardia pacing.