Can optimization of pacing settings compensate for a non-optimal left ventricular pacing site?

Bogaard, Margot D.; Doevendans, Pieter A.; Leenders, Geert E.; Loh, Peter; Hauer, Richard N.W.; Wessel, Harry van; Meine, Mathias

doi:10.1093/europace/euq167

Cited by 47 publications

(40 citation statements)

References 33 publications

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“…2 For standard CRT delivery, the atrioventricular pacing interval is shortened to ensure consistent left ventricular (LV) and right ventricular (RV) capture. However, it has been suggested that in addition to the activation wavefronts generated by RV and LV pacing, the physiological activation propagated through the right bundle branch may be part of the resynchronization mechanism.…”

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confidence: 99%

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

Padeletti

Pieragnoli

Ricciardi

et al. 2016

Circ: Arrhythmia and Electrophysiology

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We enrolled 12 consecutive heart failure patients with indications for CRT. The Institutional Review Board approved the protocol, © 2016 American Heart Association, Inc. Circ Arrhythm Electrophysiol Original ArticleBackground-Previous studies have investigated the role of intrinsic conduction in optimizing cardiac resynchronization therapy. We investigated the role of fusing pacing-induced activation and intrinsic conduction in cardiac resynchronization therapy by evaluating the acute hemodynamic effects of simultaneous His-bundle (HIS) and left ventricular (LV) pacing. Methods and Results-We studied 11 patients with systolic heart failure and left bundle-branch block scheduled for cardiac resynchronization therapy implantation. On implantation, LV pressure-volume data were determined via conductance catheter. Standard leads were placed in the right atrium, at the right ventricular apex, and in a coronary vein. An additional electrode was temporarily positioned in the HIS. The following pacing configurations were systematically assessed: standard biventricular (right ventricular apex+LV), LV-only, HIS, simultaneous HIS and LV (HIS+LV). Each configuration was compared with the AAI mode at multiple atrioventricular delays (AVD). In comparison with the AAI, right ventricular apex+LV and LV-only pacing resulted in improved stroke volume (85±32 mL and 86±33 mL versus 58±23 mL; P<0.001), stroke work, maximum pressure derivative, and systolic dyssynchrony at individually optimized AVD. The optimal AVD was close to the P-H interval in the majority of patients. By contrast, HIS-LV pacing improved hemodynamic indexes at all AVD (stroke volume >76 mL at all fixed intervals and 88±31 mL at optimal interval; all P<0.001). Conclusions-Standard right ventricular apex+LV and LV-only pacing enhanced systolic function and LV synchrony at individually optimized AVD close to the measured intrinsic P-H interval. By contrast, HIS+LV pacing yielded improvements, regardless of AVD setting. These findings support the hypothesis of the crucial role of intrinsic right ventricular conduction in optimal cardiac resynchronization therapy delivery. (Circ Arrhythm Electrophysiol. 2016;9:e003793.

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confidence: 99%

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

Padeletti

Pieragnoli

Ricciardi

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Determination of the pacing site is most important for the efficacy of CRT. 2 In the present case, intraoperative 2-dimensional epicardial echocardiographic measurement of circumferential strain enabled us to precisely identify the most delayed and earliest contraction points. We could also evaluate the increase in systemic blood pressure and the improvement in synchrony on a real-time basis.…”

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confidence: 72%

Successful Fontan Completion After Cardiac Resynchronization Therapy

et al. 2012

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his patient underwent a modified Norwood operation with a right ventricle-pulmonary artery shunt at the age of 7 days following the diagnosis of hypoplastic left heart syndrome with mitral and aortic atresia; this procedure was followed by bidirectional Glenn operation at the age of 5 months. The girl subsequently developed congestive heart failure despite the administration of angiotensin-converting enzyme inhibitors and ␤-blockers after the initial operation. At the age of 11 months, she required hospitalization and intravenous inotropic support. Coil embolization and surgical ligation of the aortopulmonary collaterals were performed at the age of 1 year but could not control the heart failure. The maximum plasma brain natriuretic peptide level after the second palliative operation was 3823 pg/mL. Cardiac catheterization performed at the age of 1 year and 4 months revealed ventricular dyssynchrony, ventricular ejection fraction of 36.2%, right atrial pressure of 7 mm Hg, superior vena cava pressure of

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“…The study of Bogaard and associates reported that the optimal VV delay is -30 ms (-60 ms to 5 ms) and -20 ms (-40 ms to 0 ms) at non-optimal and optimal LV lead sites, respectively [29]. Heinroth and associates compared VV delays and reported that LV preexcitation by 40 ms resulted the largest mean CO, and similar values were obtained with LV preexcitation by 20 ms and 60 ms [10].…”

Section: Vv Delaymentioning

confidence: 86%

Whether noninvasive optimization of AV and VV delays improves the response to cardiac resynchronization therapy

Urbanek

Chudzik²,

Klimczak³

et al. 2013

Cardiol J

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Can optimization of pacing settings compensate for a non-optimal left ventricular pacing site?

Abstract: Optimization of the AVD and VVD can partly compensate for a non-optimal LV pacing site. However, a combination of an optimal LV pacing site and optimized pacing settings gives the best acute haemodynamic response.

Cited by 47 publications

References 33 publications

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

Successful Fontan Completion After Cardiac Resynchronization Therapy

Whether noninvasive optimization of AV and VV delays improves the response to cardiac resynchronization therapy

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