Therapeutic potential of conduction system pacing as a method for improving cardiac output during ventricular tachycardia.

Autor: Keene D; Imperial College Healthcare NHS Trust, London, UK. d.keene@imperial.ac.uk.; Imperial College London, National Heart and Lung Institute, London, UK. d.keene@imperial.ac.uk.; National Heart and Lung Institute, Hammersmith Hospital, London, W12 0HS, UK. d.keene@imperial.ac.uk., Miyazawa AA; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Arnold AD; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Naraen A; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Kaza N; Imperial College London, National Heart and Lung Institute, London, UK., Mohal JS; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Lefroy DC; Imperial College Healthcare NHS Trust, London, UK., Lim PB; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Ng FS; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Koa-Wing M; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Qureshi NA; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Linton NWF; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Wright I; Imperial College Healthcare NHS Trust, London, UK., Peters NS; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Kanagaratnam P; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Shun-Shin MJ; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Francis DP; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK., Whinnett ZI; Imperial College Healthcare NHS Trust, London, UK.; Imperial College London, National Heart and Lung Institute, London, UK.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2024 Oct; Vol. 67 (7), pp. 1603-1613. Date of Electronic Publication: 2024 Apr 22.
DOI: 10.1007/s10840-024-01809-8
Abstrakt: Background: Ventricular tachycardia (VT) reduces cardiac output through high heart rates, loss of atrioventricular synchrony, and loss of ventricular synchrony. We studied the contribution of each mechanism and explored the potential therapeutic utility of His bundle pacing to improve cardiac output during VT.
Methods: Study 1 aimed to improve the understanding of mechanisms of harm during VT (using pacing simulated VT). In 23 patients with left ventricular impairment, we recorded continuous ECG and beat-by-beat blood pressure measurements. We assessed the hemodynamic impact of heart rate and restoration of atrial and biventricular synchrony. Study 2 investigated novel pacing interventions during clinical VT by evaluating the hemodynamic effects of His bundle pacing at 5 bpm above the VT rate in 10 patients.
Results: In Study 1, at progressively higher rates of simulated VT, systolic blood pressure declined: at rates of 125, 160, and 190 bpm, -22.2%, -42.0%, and -58.7%, respectively (ANOVA p < 0.0001). Restoring atrial synchrony alone had only a modest beneficial effect on systolic blood pressure (+ 3.6% at 160 bpm, p = 0.2117), restoring biventricular synchrony alone had a greater effect (+ 9.1% at 160 bpm, p = 0.242), and simultaneously restoring both significantly increased systolic blood pressure (+ 31.6% at 160 bpm, p = 0.0003). In Study 2, the mean rate of clinical VT was 143 ± 21 bpm. His bundle pacing increased systolic blood pressure by + 14.2% (p = 0.0023). In 6 of 10 patients, VT terminated with His bundle pacing.
Conclusions: Restoring atrial and biventricular synchrony improved hemodynamic function in simulated and clinical VT. Conduction system pacing could improve VT tolerability and treatment.
(© 2024. The Author(s).)
Databáze: MEDLINE
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