期刊
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
卷 39, 期 6, 页码 531-+出版社
WILEY-BLACKWELL
DOI: 10.1111/pace.12854
关键词
cardiac resynchronization therapy; ventricular contractility; endocardial pacing; biventricular acute hemodynamic response
资金
- Boston Scientific
- British Heart Foundation [PG/11/101/29212]
- Wellcome Trust [WT 088641/Z/09/Z]
- St. Jude Medical
- Medtronic
- NIHR Biomedical Research Centre at Guys' and St. Thomas' NHS Foundation Trust
- Rosetrees Trust
- EPSRC [EP/M012492/1] Funding Source: UKRI
- British Heart Foundation [PG/11/101/29212] Funding Source: researchfish
- Engineering and Physical Sciences Research Council [EP/H019898/1, EP/M012492/1] Funding Source: researchfish
Background: Cardiac resynchronization therapy (CRT) with biventricular epicardial (BV-CS) or endocardial left ventricular (LV) stimulation (BV-EN) improves LV hemodynamics. The effect of CRT on right ventricular function is less clear, particularly for BV-EN. Our objective was to compare the simultaneous acute hemodynamic response (AHR) of the right and left ventricles (RV and LV) with BV-CS and BV-EN in order to determine the optimal mode of CRT delivery. Methods: Nine patients with previously implanted CRT devices successfully underwent a temporary pacing study. Pressure wires measured the simultaneous AHR in both ventricles during different pacing protocols. Conventional epicardial CRT was delivered in LV-only (LV-CS) and BV-CS configurations and compared with BV-EN pacing in multiple locations using a roving decapolar catheter. Results: Best BV-EN (optimal AHR of all LV endocardial pacing sites) produced a significantly greater RV AHR compared with LV-CS and BV-CS pacing (P < 0.05). RV AHR had a significantly increased standard deviation compared to LV AHR (P < 0.05) with a weak correlation between RV and LV AHR (Spearman r(s) = -0.06). Compromised biventricular optimization, whereby RV AHR was increased at the expense of a smaller decrease in LV AHR, was achieved in 56% of cases, all with BV-EN pacing. Conclusions: BV-EN pacing produces significant increases in both LV and RV AHR, above that achievable with conventional epicardial pacing. RV AHR cannot be used as a surrogate for optimizing LV AHR; however, compromised biventricular optimization is possible. The beneficial effect of endocardial LV pacing on RV function may have important clinical benefits beyond conventional CRT.
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