TY - JOUR
T1 - Morphology of the RV electrogram during LV pacing is related to the hemodynamic effect in cardiac resynchronization therapy
AU - van Gelder, Berry M.
AU - Bracke, Frank A.
AU - Meijer, Albert
AU - Pilmeyer, Art
AU - Pijls, N.H.J.
PY - 2007/11/1
Y1 - 2007/11/1
N2 - Background: Biventricular (BiV) pacing and left ventricular (LV) pacing both improve LV function in patients with heart failure and LV dyssynchrony. We studied the hemodynamic effect of the atrioventricular (AV) interval and the associated changes in the right ventricular (RV) electrogram (EGM) during LV pacing and compared this with the hemodynamic effect of optimized sequential BiV pacing. Methods: In 16 patients with New York Heart Association (NYHA) class II to IV, sinus rhythm with normal AV conduction, left bundle branch block (LBBB), QRS > 130 ms, and optimal medical therapy, the changes in RV EGM during LV pacing with varying AV intervals were studied. The hemodynamic effect associated with these changes was evaluated by invasive measurement of LVdP/dt max and compared with the result of optimized sequential BiV pacing in the same patient. Results: All patients showed electrocardiographic fusion during LV pacing. The morphology of the RV EGM showed changes in the RV activation that indicated a shift in the extent of fusion from LV pacing. These changes were associated with significant changes in LVdP/dtmax. Baseline LV dP/dtmax was 734 ± 177 mmHg/s, which increased to 927 ± 202 mmHg/s (P<0.0001) with optimized LV pacing and to 920 ± 209 mmHg/s (P<0.0001) with optimized sequential BiV pacing. Conclusion: The RV EGM is a proper indicator for intrinsic activation over the right bundle during LV pacing and reveals the transition to fusion in the RV EGM that is associated with a decrease in LVdP/dtmax. The hemodynamic effect of optimized LV pacing is equal to optimized sequential BiV pacing.
AB - Background: Biventricular (BiV) pacing and left ventricular (LV) pacing both improve LV function in patients with heart failure and LV dyssynchrony. We studied the hemodynamic effect of the atrioventricular (AV) interval and the associated changes in the right ventricular (RV) electrogram (EGM) during LV pacing and compared this with the hemodynamic effect of optimized sequential BiV pacing. Methods: In 16 patients with New York Heart Association (NYHA) class II to IV, sinus rhythm with normal AV conduction, left bundle branch block (LBBB), QRS > 130 ms, and optimal medical therapy, the changes in RV EGM during LV pacing with varying AV intervals were studied. The hemodynamic effect associated with these changes was evaluated by invasive measurement of LVdP/dt max and compared with the result of optimized sequential BiV pacing in the same patient. Results: All patients showed electrocardiographic fusion during LV pacing. The morphology of the RV EGM showed changes in the RV activation that indicated a shift in the extent of fusion from LV pacing. These changes were associated with significant changes in LVdP/dtmax. Baseline LV dP/dtmax was 734 ± 177 mmHg/s, which increased to 927 ± 202 mmHg/s (P<0.0001) with optimized LV pacing and to 920 ± 209 mmHg/s (P<0.0001) with optimized sequential BiV pacing. Conclusion: The RV EGM is a proper indicator for intrinsic activation over the right bundle during LV pacing and reveals the transition to fusion in the RV EGM that is associated with a decrease in LVdP/dtmax. The hemodynamic effect of optimized LV pacing is equal to optimized sequential BiV pacing.
KW - Cardiac resynchronization therapy
KW - Left ventricular pacing
KW - Right ventricular electrogram
KW - Sequential biventricular pacing
UR - http://www.scopus.com/inward/record.url?scp=35748969088&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8159.2007.00875.x
DO - 10.1111/j.1540-8159.2007.00875.x
M3 - Article
C2 - 17976103
AN - SCOPUS:35748969088
SN - 0147-8389
VL - 30
SP - 1381
EP - 1387
JO - Pacing and Clinical Electrophysiology : PACE
JF - Pacing and Clinical Electrophysiology : PACE
IS - 11
ER -