AIMS: Left ventricular (LV) lead placement to the most delayed segment offers the greatest potential benefit to cardiac resynchronization therapy (CRT). We assessed the impact of interventricular (VV) optimization on acute changes in cardiac output (CO) in patients with and without LV pacing of the most delayed segment. METHODS AND RESULTS: In 124 patients, the most delayed segment was defined by speckle tracking radial strain and the LV lead position by biplane fluoroscopy. Patients were classified as either a concordant (LV lead at latest site), adjacent (within one segment), or remote (two or more segments away) LV lead. Atrioventricular (AV) and VV delays were optimized by echocardiography. Cardiac output was measured non-invasively and a >20% increase in CO from baseline (intrinsic) defined acute response. Changes in CO in patients with concordant, adjacent, or remote LV leads were recorded following atrioventricular optimization alone (AV OPT) and after combined AV and VV optimization (AV/VV OPT). Compared with AV OPT pacing, AV/VV OPT produced a greater rise in CO (5.45 ± 1.1 vs. 5.76 ± 1.2 L/min, P< 0.001) and higher acute response rates (48.4 vs. 61.3%, P= 0.041). In adjacent patients, compared with AV OPT pacing, AV/VV OPT settings increased the response rate from 36.4 to 63.6% (P= 0.037). VV optimization had no effect on acute response rates in patients with remote (26.7 vs. 33.3%, P = 0.581) or concordant LV leads (65.6 vs. 72.1%, P = 0.438). CONCLUSION: VV optimization overcomes some but not all of the deleterious effects of a suboptimal LV lead position.
AIMS: Left ventricular (LV) lead placement to the most delayed segment offers the greatest potential benefit to cardiac resynchronization therapy (CRT). We assessed the impact of interventricular (VV) optimization on acute changes in cardiac output (CO) in patients with and without LV pacing of the most delayed segment. METHODS AND RESULTS: In 124 patients, the most delayed segment was defined by speckle tracking radial strain and the LV lead position by biplane fluoroscopy. Patients were classified as either a concordant (LV lead at latest site), adjacent (within one segment), or remote (two or more segments away) LV lead. Atrioventricular (AV) and VV delays were optimized by echocardiography. Cardiac output was measured non-invasively and a >20% increase in CO from baseline (intrinsic) defined acute response. Changes in CO in patients with concordant, adjacent, or remote LV leads were recorded following atrioventricular optimization alone (AV OPT) and after combined AV and VV optimization (AV/VV OPT). Compared with AV OPT pacing, AV/VV OPT produced a greater rise in CO (5.45 ± 1.1 vs. 5.76 ± 1.2 L/min, P< 0.001) and higher acute response rates (48.4 vs. 61.3%, P= 0.041). In adjacent patients, compared with AV OPT pacing, AV/VV OPT settings increased the response rate from 36.4 to 63.6% (P= 0.037). VV optimization had no effect on acute response rates in patients with remote (26.7 vs. 33.3%, P = 0.581) or concordant LV leads (65.6 vs. 72.1%, P = 0.438). CONCLUSION: VV optimization overcomes some but not all of the deleterious effects of a suboptimal LV lead position.
Authors: Martin G St John Sutton; Ted Plappert; William T Abraham; Andrew L Smith; David B DeLurgio; Angel R Leon; Evan Loh; Dusan Z Kocovic; Westby G Fisher; Myrvin Ellestad; John Messenger; Kristin Kruger; Kathryn E Hilpisch; Michael R S Hill Journal: Circulation Date: 2003-03-31 Impact factor: 29.690
Authors: William T Abraham; Westby G Fisher; Andrew L Smith; David B Delurgio; Angel R Leon; Evan Loh; Dusan Z Kocovic; Milton Packer; Alfredo L Clavell; David L Hayes; Myrvin Ellestad; Robin J Trupp; Jackie Underwood; Faith Pickering; Cindy Truex; Peggy McAtee; John Messenger Journal: N Engl J Med Date: 2002-06-13 Impact factor: 91.245
Authors: Michael R Bristow; Leslie A Saxon; John Boehmer; Steven Krueger; David A Kass; Teresa De Marco; Peter Carson; Lorenzo DiCarlo; David DeMets; Bill G White; Dale W DeVries; Arthur M Feldman Journal: N Engl J Med Date: 2004-05-20 Impact factor: 91.245
Authors: Marina Leitman; Peter Lysyansky; Stanislav Sidenko; Vladimir Shir; Eli Peleg; Michal Binenbaum; Edo Kaluski; Ricardo Krakover; Zvi Vered Journal: J Am Soc Echocardiogr Date: 2004-10 Impact factor: 5.251
Authors: Margot D Bogaard; Pieter A Doevendans; Geert E Leenders; Peter Loh; Richard N W Hauer; Harry van Wessel; Mathias Meine Journal: Europace Date: 2010-06-18 Impact factor: 5.214
Authors: N B Schiller; P M Shah; M Crawford; A DeMaria; R Devereux; H Feigenbaum; H Gutgesell; N Reichek; D Sahn; I Schnittger Journal: J Am Soc Echocardiogr Date: 1989 Sep-Oct Impact factor: 5.251
Authors: Berry M van Gelder; Frank A Bracke; Albert Meijer; Lex J M Lakerveld; Nico H J Pijls Journal: Am J Cardiol Date: 2004-06-15 Impact factor: 2.778
Authors: Ralf Koos; Anil-Martin Sinha; Kai Markus; Ole-Alexander Breithardt; Karl Mischke; Markus Zarse; Michael Schmid; Rüdiger Autschbach; Peter Hanrath; Christoph Stellbrink Journal: Am J Cardiol Date: 2004-07-01 Impact factor: 2.778
Authors: Arianna Di Molfetta; Giovanni B Forleo; Luca Santini; Libera Fresiello; Lida P Papavasileiou; Giulia Magliano; Domenico Sergi; Ambrogio Capria; Francesco Romeo; Gianfranco Ferrari Journal: J Artif Organs Date: 2013-03-16 Impact factor: 1.731
Authors: Angela W C Lee; Andrew Crozier; Eoin R Hyde; Pablo Lamata; Michael Truong; Manav Sohal; Thomas Jackson; Jonathan M Behar; Simon Claridge; Anoop Shetty; Eva Sammut; Gernot Plank; Christopher Aldo Rinaldi; Steven Niederer Journal: J Cardiovasc Electrophysiol Date: 2017-01-14