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Timing of the Left Ventricular Electrogram and Acute Hemodynamic Changes During Implant of Cardiac Resynchronization Therapy Devices
Author(s) -
VAN GELDER BERRY M.,
MEIJER ALBERT,
BRACKE FRANK A.
Publication year - 2009
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.1540-8159.2008.02262.x
Subject(s) - medicine , cardiology , qrs complex , cardiac resynchronization therapy , hemodynamics , coronary sinus , heart failure , ejection fraction
Study Objective: To examine the relationship between timing of the left ventricular (LV) electrogram (EGM) and its acute hemodynamic effect on instantaneous change in LV pressure (LVdP/dt MAX ).Patients and Methods: In 30 patients (mean = age 67 ± 7.9 years) who underwent implant of cardiac resynchronization therapy systems, the right ventricular (RV) lead was implanted at the RV apex (n = 23) or RV septum (n = 7). The LV lead was placed in a posterior (n = 14) or posterolateral (n = 16) coronary sinus tributary. QRS duration, interval from Q wave to intrinsic deflection of the LV EGM (Q‐LV), and interval between intrinsic deflection of RV EGM and LV EGM (RV‐LV interval) were measured. The measurements were correlated with the hemodynamic effects of optimized biventricular (BiV) stimulation, using the Pearson correlation coefficient.Results: The mean LVdP/dt MAX at baseline was 734 ± 180 mmHg/s, and increased to 905 ± 165 mmHg/s during simultaneous BiV pacing, and to 933 ± 172 mmHg/s after V‐V interval optimization. The Pearson correlation coefficient R between QRS duration, the Q‐LV interval, and the RV‐LV interval at the respective LVdP/dt MAX was 0.291 (P = 0.66), 0.348 (P = 0.030), and 0.340 (P = 0.033).Conclusions: Similar significant correlations were observed between the acute hemodynamic effect of optimized BiV stimulation and the Q‐LV and the RV‐LV intervals. However, individual measurements showed an 80‐ms cut‐off for the Q‐LV interval, beyond which the increase in LVdP/dt MAX was <10%. .