Pulse arrival time variation as a non-invasive marker of acute response to cardiac resynchronization therapy.

Autor:	Villegas-Martinez M; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Odland HH; Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Pacertool AS, Oslo, Norway., Hammersbøen LE; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Sletten OJ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Stugaard M; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Witsø M; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Khan F; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Wajdan A; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.; Department of Informatics, University of Oslo, Oslo, Norway., Elle OJ; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.; Department of Informatics, University of Oslo, Oslo, Norway., Remme EW; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.; Pacertool AS, Oslo, Norway.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2023 Mar 30; Vol. 25 (3), pp. 1183-1192.
DOI:	10.1093/europace/euad013
Abstrakt:	Aims: Successful cardiac resynchronization therapy (CRT) shortens the pre-ejection period (PEP) which is prolonged in the left bundle branch block (LBBB). In a combined animal and patient study, we investigated if changes in the pulse arrival time (PAT) could be used to measure acute changes in PEP during CRT implantation and hence be used to evaluate acute CRT response non-invasively and in real time. Methods and Results: In six canines, a pulse transducer was attached to a lower limb and PAT was measured together with left ventricular (LV) pressure by micromanometer at baseline, after induction of LBBB and during biventricular pacing. Time-to-peak LV dP/dt (Td) was used as a surrogate for PEP. In twelve LBBB patients during implantation of CRT, LV and femoral pressures were measured at baseline and during five different pacing configurations. PAT increased from baseline (277 ± 9 ms) to LBBB (313 ± 16 ms, P < 0.05) and shortened with biventricular pacing (290 ± 16 ms, P < 0.05) in animals. There was a strong relationship between changes in PAT and Td in patients (r2 = 0.91). Two patients were classified as non-responders at 6 months follow-up. CRT decreased PAT from 320 ± 41 to 298 ± 39 ms (P < 0.05) in the responders, while PAT increased by 5 and 8 ms in the two non-responders. Conclusion: This proof-of-concept study indicates that PAT can be used as a simple, non-invasive method to assess the acute effects of CRT in real time with the potential to identify long-term response in patients. Competing Interests: Conflict of interest: H.H.O. holds patents within the field of CRT and is a stockholder at Pacertool. The remaining authors report no potential conflicts of interest. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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