Comparison of the haemodynamics of different pacing sites in patients undergoing resynchronisation treatment: need for individualisation of lead localisation

Abstract

Individualisation of pacing configuration for biventricular pacing leads to further haemodynamic improvement in patients with heart failure and reduces the number of patients not responding to this therapy.

A Simultaneous X-Ray/MRI and Noncontact Mapping Study of the Acute Hemodynamic Effect of Left Ventricular Endocardial and Epicardial Cardiac Resynchronization Therapy in Humans

“…This mechanism may in part explain the significant intraindividual and interindividual variability that has been found in other studies in the optimal LV lead position in patients undergoing CRT. 4,5 In our study, a lateral position of the LV endocardial lead was shown to be superior to posterior or anterior lead positions when pacing outside areas of slow conduction. This is consistent with the premise that resynchronization therapy is best delivered using a laterally positioned electrode to reverse the effect of LV dyssynchrony, which gives rise to late activation of the lateral LV wall.…”

“…In keeping with this concept, other investigators have demonstrated using acute hemodynamic studies that the optimal LV lead position varies considerably between patients and may need to be optimized on an individual basis. 4,5 However, a major limitation of the coronary sinus approach is the limited number of optimal sites available to capture.…”

Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead

“…5, 6 Many factors have been associated to a poor response, including pacing from areas of scar, 18 enrolling patients with only slightly enlarged QRS (<150 ms), 19 LV lead positioning in an anterior branch of the CS. 7 Recently, data from the MADIT-CRT trial suggested that the response to biventricular pacing may vary according to the site of pacing, with the midventricular and basal portions of the lateral wall generally associated with a better response compared with apical sites. 8 Although most of the available devices allow many configurations of LV pacing (tip to ring, ring to tip, tip to coil, etc), the pacing site remains substantially unchanged.…”

Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position

“…Most studies have concentrated on the position of the LV lead with respect to acute and chronic response to CRT [22,23,30,31]. The positioning of the RV lead in relation to CRT response is less well understood.…”

“…Acute response was defined as an improvement in LV dP/dt max of ≥10% versus fixed rate atrial/RV pacing [22,23]. Patients were deemed to have remodelled if at 6 months post implant there was a ≥15% reduction in LV end-systolic volume (ESV) measured using Simpson's modified biplane method on 2D echo images [24,25].…”