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Upgrading to Biventricular Pacing Guided by Pressure–Volume Loop Analysis During Implantation
Author(s) -
HM DELNOY PETER PAUL,
OTTERVANGER JAN PAUL,
VOS DICK HS,
ELVAN ARIF,
MISIER ANAND R RAMDAT,
BEUKEMA WILLEM P,
STEENDIJK PAUL,
VAN HEMEL NORBERT M
Publication year - 2011
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2010.01968.x
Subject(s) - medicine , cardiology , cardiac resynchronization therapy , ejection fraction , stroke volume , heart failure , mitral regurgitation , hemodynamics , lead (geology) , cardiac output , geomorphology , geology
Pressure–Volume Loop Analyses during CRT Implants. Introduction : cardiac resynchronization therapy (CRT) may improve prognosis in patients with chronic right ventricular (RV) pacing, and optimal lead position can decrease nonresponders. We evaluated the clinical and echocardiographic response to CRT in patients with previous chronic RV pacing, using pressure–volume loop analyses to determine the optimal left ventricular (LV) lead position during implantation.Methods and Results : In this single‐blinded, randomized, controlled crossover study, 40 patients with chronic RV apical pacing and symptoms of heart failure, decreased LV ejection fraction (LVEF) or dyssynchrony were included. During implantation, stroke work (SW), LVEF, cardiac output, and LV dP/dt max were assessed by a conductance catheter. Clinical and echocardiographic response was studied during a 3‐month period of RV pacing (RV period, LV lead inactive) and a 3‐month period of biventricular pacing (CRT period). At the optimal LV lead position, SW (37 ± 41%), LVEF (16 ± 13%), cardiac output (29 ± 16%), and LV dP/dt max increased (11 ± 11%) significantly during biventricular pacing compared to baseline. Additional benefit could be achieved by pressure–volume loop guided selection of the best left‐sided pacing location. RV outflow tract pacing did not improve hemodynamics. During follow‐up, symptoms improved during CRT, VO 2,max increased 10% and significant improvements in LVEF, LV volumes, and mitral regurgitation were observed as compared to the RV period.Conclusions : CRT in patients with chronic RV pacing causes significant improvement of both LV function as measured by pressure–volume loops during implantation and clinical and echocardiographic improvement during follow‐up. Pressure–volume loops during implantation may facilitate selection of the most optimal pacing site . (J Cardiovasc Electrophysiol, Vol. 22, pp. 677‐683, June 2011)