The concept of triple wavefront fusion during biventricular pacing: Using the EGM to produce the best acute hemodynamic improvement in CRT.

Autor: Ter Horst IAH; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands., Bogaard MD; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands., Tuinenburg AE; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands., Mast TP; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands., de Boer TP; Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands., Doevendans PAFM; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands., Meine M; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: Pacing and clinical electrophysiology : PACE [Pacing Clin Electrophysiol] 2017 Jul; Vol. 40 (7), pp. 873-882. Date of Electronic Publication: 2017 Jun 16.
DOI: 10.1111/pace.13118
Abstrakt: Background: Previous reports suggest that biventricular pacing (BiVp) fused with intrinsic conduction (BiVp-fusion, triple wavefront fusion) is associated with improved resynchronization compared to pure-BiVp in cardiac resynchronization therapy (CRT). This study aimed to assess the association between acute hemodynamic benefit of CRT and signs of BiVp-fusion by using a novel electrogram (EGM)-based method.
Methods: In 17 patients undergoing CRT implantation, 28 combinations of atrioventricular (AV) and interventricular (VV) delays were applied while invasively measuring acute hemodynamic response based on maximum rate of left ventricular (LV) pressure rise (LV dP/dt max ) to assess optimal BiVp settings. BiVp-fusion was noted if farfield signal (caused by first intrinsic ventricular depolarization) was seen prior to right ventricular (RV) pacing (RVp) artifact on integrated bipolar RV EGM, or QRS morphology changed compared to pure-BiVp (short AV-delay) as seen on electrocardiogram (ECG).
Results: Mean optimal RVp timing was at 98 ± 17% of intrinsic right atrial (RA)-RV farfield (interval from right atrial pace or sense to RV farfield signal) interval, while preactivating the LV at 50 ± 11% of RA-RV sense (interval from right atrial pace or sense to RV sense interval) interval. BiVp-fusion was noted in 16 of 17 (94%) patients on ECG during optimal BiVp. Eight of these patients showed intrinsic farfield signal prior to RVp artifact on RV EGM. In the remaining eight, the RVp was paced just within the RA-RV farfield interval with a mean of 25 ± 14 ms prior to the onset; therefore, the intrinsic farfield was masked.
Conclusion: Optimal hemodynamic BiVp facilitates triple wavefront fusion, by pacing the RV around the onset of intrinsic farfield signal on RV EGM, while preactivating the LV. Aiming at BiVp-fusion could be a target for noninvasive EGM-based CRT device setting optimization.
(© 2017 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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