Impact of VV optimization in relation to left ventricular lead position: an acute haemodynamic study
| Autor: | Munmohan Virdee, Fakhar Z. Khan, Philip A. Read, David Begley, David P. Dutka, Peter J. Pugh, Simon P. Fynn |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Male
Cardiac output medicine.medical_specialty Ventricular lead Heart Ventricles medicine.medical_treatment Bundle-Branch Block Cardiac resynchronization therapy Hemodynamics Cardiac Resynchronization Therapy Ventricular Dysfunction Left Clinical Research Physiology (medical) Internal medicine Humans Medicine Fluoroscopy Cardiac Resynchronization Therapy Devices Cardiac Output Electrodes Aged Aged 80 and over Heart Failure Bundle branch block medicine.diagnostic_test business.industry Reproducibility of Results Middle Aged medicine.disease Treatment Outcome Echocardiography Heart failure Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Europace. 13:845-852 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/eur037 |
| Popis: | Aims Left ventricular (LV) lead placement to the most delayed segment offers the greatest potential benefit to cardiac resynchronization therapy (CRT). We assessed the impact of interventricular (VV) optimization on acute changes in cardiac output (CO) in patients with and without LV pacing of the most delayed segment. Methods and results In 124 patients, the most delayed segment was defined by speckle tracking radial strain and the LV lead position by biplane fluoroscopy. Patients were classified as either a concordant (LV lead at latest site), adjacent (within one segment), or remote (two or more segments away) LV lead. Atrioventricular (AV) and VV delays were optimized by echocardiography. Cardiac output was measured non-invasively and a >20% increase in CO from baseline (intrinsic) defined acute response. Changes in CO in patients with concordant, adjacent, or remote LV leads were recorded following atrioventricular optimization alone (AV OPT) and after combined AV and VV optimization (AV/VV OPT). Compared with AV OPT pacing, AV/VV OPT produced a greater rise in CO (5.45 ± 1.1 vs. 5.76 ± 1.2 L/min, P < 0.001) and higher acute response rates (48.4 vs. 61.3%, P = 0.041). In adjacent patients, compared with AV OPT pacing, AV/VV OPT settings increased the response rate from 36.4 to 63.6% ( P = 0.037). VV optimization had no effect on acute response rates in patients with remote (26.7 vs. 33.3%, P = 0.581) or concordant LV leads (65.6 vs. 72.1%, P = 0.438). Conclusion VV optimization overcomes some but not all of the deleterious effects of a suboptimal LV lead position. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|