Variation in optimal hemodynamic atrio-ventricular delay of biventricular pacing with different endocardial left ventricular lead locations using precision hemodynamics.

Autor: Butcher CJT; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK.; NHLI, Imperial College London, London, UK., Cantor E; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK.; NHLI, Imperial College London, London, UK., Sohaib A; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK.; NHLI, Imperial College London, London, UK., Shun-Shin MJ; NHLI, Imperial College London, London, UK.; International Centre for Circulatory Health, Imperial College London, London, UK., Haynes R; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Khan H; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK.; NHLI, Imperial College London, London, UK., Kyriacou A; Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., Shi R; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Chen Z; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Haldar S; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Cleland JGF; NHLI, Imperial College London, London, UK., Hussain W; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Markides V; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Jones DG; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Lane RE; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Mason MJ; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK., Whinnett ZI; NHLI, Imperial College London, London, UK.; International Centre for Circulatory Health, Imperial College London, London, UK., Francis DP; NHLI, Imperial College London, London, UK.; International Centre for Circulatory Health, Imperial College London, London, UK., Wong T; Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust, London, UK.; NHLI, Imperial College London, London, UK.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2023 Jun; Vol. 34 (6), pp. 1431-1440. Date of Electronic Publication: 2023 May 26.
DOI: 10.1111/jce.15862
Abstrakt: Introduction: It is not known whether the optimal atrioventricular (AV opt ) delay varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration.
Methods: We assessed the hemodynamic AV opt in patients with chronic heart failure undergoing endocardial LV lead implantation. AV opt was assessed during atrio-BiVP with a "roving LV lead." Up to four locations were studied: mid-lateral wall, mid-septum (or a close alternative), site of greatest hemodynamic improvement, and LV lead implant site. The AV opt was compared to a fixed AV delay of 180 ms.
Results: Seventeen patients were included (12 male, aged 66.5 ± 12.8 years, ejection fraction 26 ± 7%, 16 left bundle branch block or high percentage of right ventricular pacing [RVP], QRS duration 167 ± 27 ms). In most locations (62/63), AV opt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, interquartile range [IQR] 4-9 mmHg). Compared to a fixed AV delay, the hemodynamic improvement at AV opt was higher (1 mmHg, IQR 0.2-2.6 mmHg, p < .001). Within most patients (16/17), we observed a difference in AV opt between pacing sites (median paced AV opt 209 ms, IQR 117-250). Within this range, the hemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6 mmHg).
Conclusion: Within a patient, different endocardial LV lead locations have slightly different hemodynamic AV opt which are superior to a fixed AV delay. The hemodynamic consequence of applying an optimum from a different lead location is small.
(© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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