Synchronous Ventricular Pacing without Crossing the Tricuspid Valve or Entering the Coronary SinusâPreliminary Results
| Autor: | Yasuo Okumura, Charles J. Bruce, Douglas L. Packer, Benhur D. Henz, Andrew J. Danielsen, B B S Susan Johnson, Paul A. Friedman, Samuel J. Asirvatham |
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| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Heart Ventricles Cardiomyopathy Pilot Projects Both ventricles Free wall QRS complex Dogs Heart Conduction System Physiology (medical) Internal medicine medicine Animals cardiovascular diseases Coronary sinus Tricuspid valve business.industry Cardiac Pacing Artificial Coronary Sinus Ventricular pacing medicine.disease Atrioventricular septum Treatment Outcome medicine.anatomical_structure cardiovascular system Cardiology Tricuspid Valve Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiovascular Electrophysiology. 20:1391-1397 |
| ISSN: | 1540-8167 1045-3873 |
| DOI: | 10.1111/j.1540-8167.2009.01556.x |
| Popis: | Background: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV). Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony. Results: The lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. The QRS duration was less with AVS compared with RVA pacing (89 ± 4 ms vs. 100 ± 11 ms [P < 0.0001, GEE P = 0.03]). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 ± 91 ms vs. 250 ± 11 ms [P < 0.0001, GEE P = 0.006]). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 ± 7.7 vs. 30.8 ± 11.6 [P = 0.01, GEE P = 0.07]). The interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 ± 6.4 ms vs. 31.1 ± 11.7 ms [P = 0.005, GEE P = 0.02]). Conclusion: The AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV. |
| Databáze: | OpenAIRE |
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