Bifocal left ventricular stimulation or the optimal left ventricular stimulation site in cardiac resynchronization therapy: a pressure-volume loop study
| Autor: | Cornelis P. Allaart, Albert C. van Rossum, Peter-Paul Delnoy, Gerben J. de Roest, LiNa Wu, Matthijs L. Hendriks, Carel C. de Cock |
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| Přispěvatelé: | Cardiology, ICaR - Heartfailure and pulmonary arterial hypertension |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Haemodynamic response Heart Ventricles medicine.medical_treatment Cardiac resynchronization therapy Hemodynamics Stimulation 030204 cardiovascular system & hematology Ventricular Function Left Cardiac Resynchronization Therapy Cicatrix Electrocardiography 03 medical and health sciences QRS complex 0302 clinical medicine Physiology (medical) Internal medicine Ventricular Pressure medicine Humans 030212 general & internal medicine Aged Netherlands Heart Failure medicine.diagnostic_test business.industry Middle Aged medicine.disease Magnetic Resonance Imaging Heart failure Linear Models Ventricular pressure Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | de Roest, G J, Wu, L, de Cock, C C, Delnoy, P-P H M, Hendriks, M L, van Rossum, A C & Allaart, C P 2016, ' Bifocal left ventricular stimulation or the optimal left ventricular stimulation site in cardiac resynchronization therapy: a pressure-volume loop study ', Europace, vol. 18, no. 7, pp. 1030-1037 . https://doi.org/10.1093/europace/euv280 Europace, 18(7), 1030-1037. Oxford University Press |
| ISSN: | 1099-5129 |
| DOI: | 10.1093/europace/euv280 |
| Popis: | Aims Several implantation strategies have been proposed to improve response to cardiac resynchronization therapy (CRT), including bifocal left ventricular (LV) stimulation and optimal single-LV lead placement. This study aimed to compare these two strategies during invasive pressure–volume (PV) loop measurements. Methods and results Thirty-three patients eligible for CRT were included [21 (64%) men, 20 (61%) ischaemic aetiology, QRS 155 ± 23 ms], and underwent cardiac magnetic resonance (CMR) imaging and invasive PV loop measurements. Left ventricular pump function was characterized by stroke work (SW) and d P /d t max (5.1 ± 3.4 L mmHg and 856 ± 190 mmHg/s, respectively). Haemodynamic response was assessed during stimulation at single-LV sites and during bifocal LV [anterolateral and posterolateral (PL)] stimulation. Response during bifocal LV stimulation was not significantly higher compared with standard PL pacing (SW; β = 9.4 ± 5.4, P = 0.080; d P /d t max, β = 0.2 ± 1.9, P = 0.922). However, mean pump function improvement was significantly higher during stimulation at the optimal LV site compared with bifocal LV stimulation (SW; β = 12.7 ± 5.1, P = 0.012; d P /d t max, β = 3.3 ± 1.2, P = 0.020). Myocardial tissue properties were assessed by CMR tissue tagging. Mechanical activation at the optimal LV site was significantly more delayed compared with the worst LV site (431 ± 93 ms vs. 326 ± 127 ms; P = 0.004). Conclusion Stimulation at the optimal LV site showed a significantly higher pump function improvement compared with bifocal LV stimulation. Mechanical activation at the optimal LV site was significantly more delayed compared with the non-optimal LV site. In general, these results suggest that implantation of a second LV lead yields no additional benefit over implantation of one optimally placed LV lead. However, a bifocal approach might be beneficial in the individual patient. |
| Databáze: | OpenAIRE |
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