Left ventricular scar and the acute hemodynamic effects of multivein and multipolar pacing in cardiac resynchronization
| Autor: | Zachary I. Whinnett, Darrell Francis, Joeri Heynens, Berthold Stegemann, Maciej Sterliński, Adam Sokal, Radosław Lenarczyk, Christopher A. Rinaldi, Frederic Van Heuverswyn, Tom Jackson, Marc Vanderheyden, Richard Cornelussen |
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| Přispěvatelé: | British Heart Foundation |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
STIMULATION
lcsh:Diseases of the circulatory (Cardiovascular) system Cardiac & Cardiovascular Systems Haemodynamic response CRT cardiac resynchronization therapy medicine.medical_treatment Hemodynamics 030204 cardiovascular system & hematology THERAPY HF heart failure 030218 nuclear medicine & medical imaging 0302 clinical medicine CMR cardiac magnetic resonance Medicine and Health Sciences Lead (electronics) Left ventricular scar MULTISITE Cardiac resynchronization therapy response Left bundle branch block Acute hemodynamic SITE LBBB left bundle branch block MVP multivein pacing INSIGHTS Cardiology Cardiology and Cardiovascular Medicine Life Sciences & Biomedicine medicine.medical_specialty AHR acute hemodynamic response Acute hemodynamic response LEAD 03 medical and health sciences QRS complex MEL multielectrode lead Internal medicine medicine BiV biventricular LV left ventricular Hemodynamic effects Original Paper Science & Technology business.industry CMR-LGE cardiac magnetic resonance late gadolinium enhancement VEIN medicine.disease MPP multipolar pacing CI confidence interval OR odds ratio Multisite pacing lcsh:RC666-701 Cardiac resynchronization Cardiovascular System & Cardiology ECG electrocardiogram business |
| Zdroj: | International Journal of Cardiology: Heart & Vasculature, Vol 19, Iss, Pp 14-19 (2018) IJC HEART & VASCULATURE International Journal of Cardiology. Heart & Vasculature |
| ISSN: | 2352-9067 |
| Popis: | Background: We sought to determine whether presence, amount and distribution of scar impacts the degree of acute hemodynamic response (AHR) with multisite pacing.Multi-vein pacing (MVP) or multipolar pacing (MPP) with a multi-electrode left ventricular (LV) lead may offer benefits over conventional biventricular pacing in patients with myocardial scar. Methods: In this multi-center study left bundle branch block patients underwent an hemodynamic pacing study measuring LV dP/dtmax. Patients had cardiac magnetic resonance scar imaging to assess the effect of scar presence, amount and distribution on AHR. Results: 24 patients (QRS 171 ± 20 ms) completed the study (83% male). An ischemic etiology was present in 58% and the mean scar volume was 6.0 ± 7.0%. Overall discounting scar, MPP and MVP showed no significant AHR increase compared to an optimized “best BiV” (BestBiV) site. In a minority of patients (6/24) receiver-operator characteristic analysis of scar volume (cut off 8.48%) predicted a small AHR improvement with MPP (sensitivity 83%, specificity 94%) but not MVP. Patients with scar volume > 8.48% had a MPP-BestBiV of 3 ± 6.3% vs. −6.4 ± 7.7% for those below the cutoff. There was a significant correlation between the difference in AHR and scar volume for MPP-BestBiV (R = 0.49, p = 0.02) but not MVP-BestBiV(R = 0.111, p = 0.62). The multielectrode lead positioned in scar predicted MPP AHR improvement (p = 0.04). Conclusions: Multisite pacing with MPP and MVP shows no AHR benefit in all-comers compared to optimized BestBiV pacing. There was a minority of patients with significant scar volume in relation to the LV site that exhibited a small AHR improvement with MPP.(Study identifier NCT01883141) Keywords: Cardiac resynchronization therapy, Multisite pacing, Acute hemodynamic response, Left ventricular scar |
| Databáze: | OpenAIRE |
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