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Does RV Lead Positioning Provide Additional Benefit to Cardiac Resynchronization Therapy in Patients with Advanced Heart Failure?
Author(s) -
SHIMANO MASAYUKI,
INDEN YASUYA,
YOSHIDA YUKIHIKO,
TSUJI YUKIOMI,
TSUBOI NAOYA,
OKADA TARO,
YAMADA TAKUMI,
MURAKAMI YOSHIMASA,
TAKADA YASUNOBU,
HIRAYAMA HARUO,
MUROHARA TOYOAKI
Publication year - 2006
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 - 10.1111/j.1540-8159.2006.00500.x
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , lead (geology) , heart failure , hemodynamics , ventricular pacing , catheter , apex (geometry) , cardiac pacing , ejection fraction , surgery , anatomy , geomorphology , geology
Background and Objectives: The left ventricular (LV) stimulation site is currently recommended to position the lead at the lateral wall. However, little is known as to whether right ventricular (RV) lead positioning is also important for cardiac resynchronization therapy. This study compared the acute hemodynamic response to biventricular pacing (BiV) at two different RV stimulation sites: RV high septum (RVHS) and RV apex (RVA).Methods and Results: Using micro‐manometer‐tipped catheter, LV pressure was measured during BiV pacing at RV (RVA or RVHS) and LV free wall in 33 patients. Changes in LV dP/dt max and dP/dt min from baseline were compared between RVA and RVHS. BiV pacing increased dP/dt max by 30.3 ± 1.2% in RVHS and by 33.3 ± 1.7% in RVA (P = n.s.), and decreased dP/dt min by 11.4 ± 0.7% in RVHS and by 13.0 ± 1.0% in RVA (P = n.s.). To explore the optimal combination of RV and LV stimulation sites, we assessed separately the role of RV positioning with LV pacing at anterolateral (AL), lateral (LAT), or posterolateral (PL) segment. When the LV was paced at AL or LAT, the increase in dP/dt max with RVHS pacing was smaller than that with RVA pacing (AL: 12.2 ± 2.2% vs 19.3 ± 2.1%, P < 0.05; LAT: 22.0 ± 2.7% vs 28.5 ± 2.2%, P < 0.05). There was no difference in dP/dt min between RVHS‐ and RVA pacing in individual LV segments.Conclusions: RVHS stimulation has no overall advantage as an alternative stimulation site for RVA during BiV pacing. RVHS was equivalent with RVA in combination with the PL LV site, while RVA was superior to RVHS in combination with AL or LAT LV site.