Avoidance of right ventricular pacing in cardiac resynchronization therapy improves right ventricular hemodynamics in heart failure patients.
BACKGROUND: Cardiac resynchronization therapy (CRT) applied by pacing the left and right ventricles (BiV) has been shown to provide synchronous left ventricular (LV) contraction in heart failure patients. CRT may also be accomplished through synchronization of a properly timed LV pacing impulse with...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 18; no. 5; pp. 497 - 505 |
|---|---|
| Autores principales: | , , , , , |
| Formato: | Journal Article |
| Publicado: |
Wiley-Blackwell
May2007
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105980589&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105980589 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: May2007 vid: 18 iid: 5 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 105980589 2009573538 NLM17428272 105980589 ppf: 497 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Avoidance of right ventricular pacing in cardiac resynchronization therapy improves right ventricular hemodynamics in heart failure patients. aug: au: Lee KL Burnes JE Mullen TJ Hettrick DA Tse HF Lau CP sug: subj: Cardiac Resynchronization Therapy Methods Heart Failure Prevention and Control Ventricular Dysfunction, Left Prevention and Control Ventricular Dysfunction, Right Prevention and Control Female Heart Failure Complications Male Middle Age Treatment Outcomes Ventricular Dysfunction, Left Etiology Ventricular Dysfunction, Right Etiology Middle Aged: 45-64 years Female Male ab: BACKGROUND: Cardiac resynchronization therapy (CRT) applied by pacing the left and right ventricles (BiV) has been shown to provide synchronous left ventricular (LV) contraction in heart failure patients. CRT may also be accomplished through synchronization of a properly timed LV pacing impulse with intrinsically conducted activation wave fronts. Elimination of right ventricular (RV) pacing may provide a more physiological RV contraction pattern and reduce device current drain. We evaluated the effects of LV and BiV pacing over a range of atrioventricular intervals on the performance of both ventricles. METHODS: Acute LV and RV hemodynamic data from 17 patients with heart failure (EF = 30 +/- 1%) and a wide QRS (138 +/- 25 msec) or mechanical dyssynchrony were acquired during intrinsic rhythm, BiV, and LV pacing. RESULTS: The highest LV dP/dt(max) was achieved during LV pre- (LV paced prior to an RV sense) and BiV pacing, followed by that obtained during LV post-pacing (LV paced after an RV sense) and the lowest LV dP/dt(max) was recorded during intrinsic rhythm. Compared with BiV pacing, LV pre-pacing significantly improved RV dP/dt(max) (378 +/- 136 mmHg/second vs 397 +/- 136 mmHg/second, P < 0.05) and preserved RV cycle efficiency (61.6 +/- 14.6% vs 68.6 +/- 11.4%, P < 0.05) and stroke volume (6.6 +/- 4.4 mL vs 9.0 +/- 6.3 mL, P < 0.05). Based on LV dP/dt(max), the optimal atrioventricular interval could be estimated by subtracting 30 msec from the intrinsic atrial to sensed RV interval. CONCLUSIONS: Synchronized LV pacing produces acute LV and systemic hemodynamic benefits similar to BiV pacing. LV pacing at an appropriate atrioventricular interval prior to the RV sensed impulse provides superior RV hemodynamics compared with BiV pacing. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|