Epicardial left ventricular lead placement for cardiac resynchronization therapy: optimal pace site selection with pressure-volume loops

Autor: F. H. Van Der Veen, Gijs Geskes, B Phelps, T. Van der Nagel, Andre Dekker, Jos G. Maessen, B. Dijkman
Rok vydání: 2004
Předmět:
Adult
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
medicine.medical_treatment
Bundle-Branch Block
Cardiac resynchronization therapy
Risk Assessment
Severity of Illness Index
Sampling Studies
Statistics
Nonparametric
Ventricular Dysfunction
Left
Internal medicine
medicine
Humans
Minimally Invasive Surgical Procedures
cardiovascular diseases
Coronary sinus
Aged
Probability
Heart Failure
Ejection fraction
business.industry
Left bundle branch block
Body Surface Potential Mapping
Cardiac Pacing
Artificial
Hemodynamics
Middle Aged
medicine.disease
Electrodes
Implanted
Surgery
Treatment Outcome
medicine.anatomical_structure
Ventricle
Heart failure
Circulatory system
Ventricular pressure
Cardiology
cardiovascular system
Female
business
Cardiology and Cardiovascular Medicine
Follow-Up Studies
Zdroj: The Journal of Thoracic and Cardiovascular Surgery. 127(6):1641-1647
ISSN: 0022-5223
DOI: 10.1016/j.jtcvs.2003.10.052
Popis: Objectives Patients in heart failure with left bundle branch block benefit from cardiac resynchronization therapy. Usually the left ventricular pacing lead is placed by coronary sinus catheterization; however, this procedure is not always successful, and patients may be referred for surgical epicardial lead placement. The objective of this study was to develop a method to guide epicardial lead placement in cardiac resynchronization therapy. Methods Eleven patients in heart failure who were eligible for cardiac resynchronization therapy were referred for surgery because of failed coronary sinus left ventricular lead implantation. Minithoracotomy or thoracoscopy was performed, and a temporary epicardial electrode was used for biventricular pacing at various sites on the left ventricle. Pressure-volume loops with the conductance catheter were used to select the best site for each individual patient. Results Relative to the baseline situation, biventricular pacing with an optimal left ventricular lead position significantly increased stroke volume (+39%, P = .01), maximal left ventricular pressure derivative (+20%, P = .02), ejection fraction (+30%, P = .007), and stroke work (+66%, P = .006) and reduced end-systolic volume (−6%, P = .04). In contrast, biventricular pacing at a suboptimal site did not significantly change left ventricular function and even worsened it in some cases. Conclusions To optimize cardiac resynchronization therapy with epicardial leads, mapping to determine the best pace site is a prerequisite. Pressure-volume loops offer real-time guidance for targeting epicardial lead placement during minimal invasive surgery.
Databáze: OpenAIRE
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