CARDIAC RESYNCHRONIZATION THERAPY: EFFECT OF OPTIMIZING THE V-V INTERVAL IN HEART FAILURE
| Autor: | Lynne Williams, Michael P. Frenneaux, Berthold Stegemann, Vince Paul, Susan M. Ellery, Kiran Patel, Robert A. Bleasdale, Francisco Leyva-Leon, Paul Steendijk |
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| Jazyk: | angličtina |
| Předmět: |
Cardiac function curve
medicine.medical_specialty business.industry medicine.medical_treatment Cardiac resynchronization therapy Hemodynamics medicine.disease QRS complex Internal medicine Heart failure Cardiology cardiovascular system Medicine In patient cardiovascular diseases Patient group Cardiology and Cardiovascular Medicine business Ventricular dyssynchrony circulatory and respiratory physiology |
| Zdroj: | Journal of the American College of Cardiology, 57(14), E348-E348 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/S0735-1097(11)60348-3 |
| Popis: | Aims: Despite a marked difference in the QRS width induced by biventricular (BIVP) and left ventricular pacing (LVP), both modes of pacing are eficacious at improving cardiac function in heart failure patients with left ventricular dyssynchrony, and in a recent study we demonstrated comparable beneits from BIVP and LVP in a patient group with a narrow QRS duration and no observable dyssynchrony. We hypothesised that optimisation of the interventricular pacing interval may further improve LV function. Methods: Twenty ive heart failure patients with a narrow QRS duration and 12 with a broad QRS duration underwent invasive haemodynamic pressure-volume studies at the time of pacemaker implantation. Absolute left ventricular stroke work (LVSW) and dP/dtMAX were determined during no pacing (VVI), in biventricular (BIVP), left ventricular (LVP) pacing mode, and over a range of interventricular timing delays. Results: Both dP/dtMAX and LVSW increased signiicantly in response to V-V delays in which the LV led by >20ms. In patients with external constraint, there was a trend towards a greater increase in LVSW with those interventricular delays where the LV was the irst chamber paced, compared with patients without external constraint, in whom near-simultaneous interventricular delays ranging from the RV leading by 12ms to the LV leading by 20ms appeared to be optimal. Conclusion: Although many would argue that the optimal V-V delay shows great variability and must be individualized, we have demonstrated optimal V-V delays in patient groups based on the presence or absence of external constraint. |
| Databáze: | OpenAIRE |
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