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Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy.

Device Optimization for Acute and Chronic CRT Background Cardiac anatomy and function adapt in response to chronic cardiac resynchronization therapy (CRT). The effects of these changes on the optimal left ventricle (LV) lead location and timing delay settings have yet to be fully explored. Objective...

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Publicado en:Journal of Cardiovascular Electrophysiology Vol. 28; no. 2; pp. 208 - 216
Autores principales: LEE, ANGELA W. C., CROZIER, ANDREW, HYDE, EOIN R., LAMATA, PABLO, TRUONG, MICHAEL, SOHAL, MANAV, JACKSON, THOMAS, BEHAR, JONATHAN M., CLARIDGE, SIMON, SHETTY, ANOOP, SAMMUT, EVA, PLANK, GERNOT, RINALDI, CHRISTOPHER ALDO, NIEDERER, STEVEN
Formato: equations & formulas research tables/charts Journal Article
Publicado: Wiley-Blackwell Feb2017
Acceso en línea:Ver este registro en EBSCOhost
Sumario:Device Optimization for Acute and Chronic CRT Background Cardiac anatomy and function adapt in response to chronic cardiac resynchronization therapy (CRT). The effects of these changes on the optimal left ventricle (LV) lead location and timing delay settings have yet to be fully explored. Objective To predict the effects of chronic CRT on the optimal LV lead location and device timing settings over time. Methods Biophysical computational cardiac models were generated for 3 patients, immediately post-implant (ACUTE) and after at least 6 months of CRT (CHRONIC). Optimal LV pacing area and device settings were predicted by pacing the ACUTE and CHRONIC models across the LV epicardium (49 sites each) with a range of 9 pacing settings and simulating the acute hemodynamic response (AHR) of the heart. Results There were statistically significant differences between the distribution of the AHR in the ACUTE and CHRONIC models (P < 0.0005 in all cases). The site delivering the maximal AHR shifted location between the ACUTE and CHRONIC models but provided a negligible improvement (<2%). The majority of the acute optimal LV pacing regions (76-100%) and device settings (76-91%) remained optimal chronically. Conclusion Optimization of the LV pacing location and device settings were important at the time of implant, with a reduced benefit over time, where the majority of the acute optimal LV pacing region and device settings remained optimal with chronic CRT.