Can We Use the Intrinsic Left Ventricular Delay (Qlv) to Optimize the Pacing Configuration for Cardiac Resynchronization Therapy With a Quadripolar Left Ventricular Lead?

Everdingen, Wouter M. van; Zweerink, Alwin; Doevendans, Pieter A.; Nguyên, Uyên Châu; Rossum, Albert C. van; Prinzen, Frits; Vernooy, Kevin; Allaart, Cornelis P.; Meine, Mathias

doi:10.1016/s0735-1097(18)31486-4

Cited by 7 publications

(11 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…32,38 A possible explanation is that a correlation with LV end-systolic volume reduction seems driven by shorter QLV values (cutoff value w95 ms) and seems to be most applicable when large disparities between the measured QLV are present. 5,38 Moreover, when compared to an anatomic approach, QLV-guided implantation may only be beneficial in patients with typical LBBB morphology. 39 Because of small differences in intrinsic activation delay when LVLP already is optimal, electrical indices such as LV-paced to RV-sensed wavefront propagation (ie, LVp-RVs) correlate poorly to QLV as well.…”

Section: Electrically Guidedmentioning

confidence: 99%

“…32 Therefore, LV-paced activation effects are highly unpredictable when based on stimulation site alone, despite widely variable acute electrical responses. 32,38 Where QLV is a measure of intrinsic electrical dyssynchrony, the difference between left and right paced-to-sensed interlead delays (LVp-RVs . RVp-LVs) can be used as a measure of paced LV-dyssynchrony.…”

Section: Electrically Guidedmentioning

confidence: 99%

“…40,41 Regardless, paced-tosensed interlead delays are not associated with LVLP or acute stroke work increase, underscoring the heterogeneity of optimal LVLP. 38 Additionally, LV latency as indicated by stimulus-to-QRS onset 40 ms also can be measured, which may be used to predict mortality and hospitalization for HF. 42 Although LV latency is associated with ischemic etiology, its presence can be related to any cause of impaired impulse propagation, prolonged refractoriness, or conduction disorders.…”

Section: Electrically Guidedmentioning

confidence: 99%

See 2 more Smart Citations

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

et al. 2021

Self Cite

View full text Add to dashboard Cite

Cardiac resynchronization therapy (CRT) greatly reduces morbidity and mortality in patients with dyssynchronous heart failure. However, despite tremendous efforts, response has been variable and can be further improved. Although optimizing left ventricular lead placement (LVLP) is arguably the cornerstone of CRT, the procedure of LVLP using the transvenous approach has remained largely unchanged for more than 2 decades. Improvements have been developed using scar location and electrical and/or mechanical mapping. Interest in conduction system pacing as an alternative to biventricular pacing has emerged recently. Conduction system pacing is promising but may not be suitable for all patients with dyssynchronous heart failure. This review underscores the importance of a patient-tailored approach and discusses the potential applications of both conduction system pacing and targeted biventricular CRT.

show abstract

Section: Electrically Guidedmentioning

confidence: 99%

Section: Electrically Guidedmentioning

confidence: 99%

Section: Electrically Guidedmentioning

confidence: 99%

See 1 more Smart Citation

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Most LV leads currently implanted are quadripolar leads which can pace the LV from four different electrodes. Each electrode is characterized by its particular electrical delay, and the acute hemodynamic benefit may vary according to the chosen electrode 15 . Moreover, some CRT devices can determine the interventricular delay both in intrinsic rhythm and during right‐ventricular (RV) pacing (RVp‐LVs).…”

Section: Introductionmentioning

confidence: 99%

Interrelationships between interventricular electrical delays in cardiac resynchronization therapy

Moubarak

Sébag

Socie

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction In cardiac resynchronization therapy, pacing the left ventricle (LV) at sites of prolonged electrical delay is associated with better outcomes. We sought to characterize the interrelationships between intrinsic, right‐ventricular (RV)‐paced, and LV‐paced interventricular delays. Methods and Results The following electrical timings were measured at implantation for all electrodes of the LV quadripolar leads: QLV, interventricular delay in intrinsic rhythm (RVs‐LVs), in RV‐paced rhythm (RVp‐LVs), and in LV‐paced rhythm (LVp‐RVs). We included 32 patients (78% men, age 72 years, LV ejection fraction 29%, left bundle branch block 84%). QLV and RVs‐LVs were correlated (R2 = .72, p < .0001), as were RVs‐LVs and RVp‐LVs (R2 = .27, p = .002) and RVp‐LVs and LVp‐RVs (R2 = .60, p < .001). Direction of activation along the four LV lead electrodes was concordant between RVs‐LVs and RVp‐LVs in only 17 (53%) patients. The latest‐activated electrodes in RVs‐LVs and RVp‐LVs were concordant in 26 (81%) patients, adjacent in 3 (9%) patients, and remote in 3 (9%) patients. Biventricular‐paced QRS duration varied by more than 10 ms between the two electrodes in half of the patients with dissimilar latest electrodes. Among the seven echocardiographic nonresponders at 6 months, the programmed electrode was remote from the latest electrode in RVs‐LVs in five patients and in RVp‐LVs in three patients. Conclusion Intrinsic and RV‐paced interventricular electrical delays are correlated, but there is substantial heterogeneity between patients. The latest‐activated electrode may be different between RVs‐LVs and RVp‐LVs, and this might have important implications in selecting the optimal LV vector.

show abstract

“…Electrical measurements such as QLV, RV‐LV duration, or QRS narrowing with pacing have shown some predictive value in populations, but lack the sensitivity and specificity to make them useful in individual patients 8‐10 . Traditionally, LV activation could only reliably be determined via invasive electrical mapping 11 .…”

Section: Introductionmentioning

confidence: 99%

The ECG Belt for CRT response trial: Design and clinical protocol

Rickard

Jackson

Biffi

et al. 2020

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

The ECG Belt for CRT response trial is designed to test the hypothesis that in patients traditionally less likely to respond to cardiac resynchronization therapy (CRT), an individualized approach utilizing the electrocardiogram (ECG) Belt to guide lead placement, vector selection, and device programming is superior to current standard of care. The ECG Belt is a noninvasive mapping technology designed to measure beat by beat electrical activation of the left ventricle by utilizing unipolar measurements from multiple ECG electrodes on the body surface. The ECG Belt for CRT response trial is a multicenter, prospective, randomized, investigational pre-market research study conducted at 48 centers in the United States, Canada, and Europe and will randomize approximately 400 subjects. The trial has three arms (enrollment will be 2:1:1, respectively): utilization of the Belt to guide implant as well as postimplant programming, utilizing the Belt to guide postimplant programming alone, and a non-Belt control arm. Adap-tivCRT will be an option in the treatment arm but not the control arms. The primary endpoint is change in left ventricular end-systolic volume between preimplant and at 6 months. This paper describes the design and analytic plan for the trial.

show abstract

Can We Use the Intrinsic Left Ventricular Delay (Qlv) to Optimize the Pacing Configuration for Cardiac Resynchronization Therapy With a Quadripolar Left Ventricular Lead?

Cited by 7 publications

References 27 publications

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

Interrelationships between interventricular electrical delays in cardiac resynchronization therapy

The ECG Belt for CRT response trial: Design and clinical protocol

Contact Info

Product

Resources

About