Anoop K Shetty1, Manav Sohal2, Zhong Chen2, Matthew R Ginks2, Julian Bostock3, Sana Amraoui2, Kyungmoo Ryu4, Stuart P Rosenberg4, Steven A Niederer5, Jas Gill2, Gerry Carr-White2, Reza Razavi5, C Aldo Rinaldi2. 1. Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK anoopshetty@doctors.org.uk. 2. Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK. 3. Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK. 4. Cardiac Rhythm Management Division, St Jude Medical, Sylmar, CA, USA. 5. Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK.
Abstract
AIMS: Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) leads or a single-quadripolar CS lead. METHODS AND RESULTS: Fifteen patients with a previously implanted CRT system received a second temporary CS lead and left ventricular (LV) endocardial catheter. A pressure wire and non-contact mapping array were placed into the LV cavity to measure LVdP/dtmax and perform electroanatomical mapping. Conventional CRT, BV-Endo, and MSP were then performed (MSP-1 via two epicardial leads and MSP-2 via a single-quadripolar lead). The best overall AHR was found using BV-Endo pacing with a 19.6 ± 13.6% increase in AHR at the optimal endocardial site over baseline (P < 0.001). There was an increase in LVdP/dtmax with MSP-1 and MSP-2 compared with conventional CRT, but this was not statistically significant. Biventricular endocardial pacing from the optimal site was significantly superior to conventional CRT (P = 0.039). The AHR achieved when BV-Endo pacing was highly site specific. Within individuals, the best pacing modality varied and was affected by the underlying substrate. Left ventricular activation times did not predict the optimal haemodynamic configuration. CONCLUSION: Biventricular endocardial pacing and not MSP was superior to conventional CRT, but was highly site specific. Within individuals, however, different methods of stimulation are optimal and may need to be tailored to the underlying substrate. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) leads or a single-quadripolar CS lead. METHODS AND RESULTS: Fifteen patients with a previously implanted CRT system received a second temporary CS lead and left ventricular (LV) endocardial catheter. A pressure wire and non-contact mapping array were placed into the LV cavity to measure LVdP/dtmax and perform electroanatomical mapping. Conventional CRT, BV-Endo, and MSP were then performed (MSP-1 via two epicardial leads and MSP-2 via a single-quadripolar lead). The best overall AHR was found using BV-Endo pacing with a 19.6 ± 13.6% increase in AHR at the optimal endocardial site over baseline (P < 0.001). There was an increase in LVdP/dtmax with MSP-1 and MSP-2 compared with conventional CRT, but this was not statistically significant. Biventricular endocardial pacing from the optimal site was significantly superior to conventional CRT (P = 0.039). The AHR achieved when BV-Endo pacing was highly site specific. Within individuals, the best pacing modality varied and was affected by the underlying substrate. Left ventricular activation times did not predict the optimal haemodynamic configuration. CONCLUSION: Biventricular endocardial pacing and not MSP was superior to conventional CRT, but was highly site specific. Within individuals, however, different methods of stimulation are optimal and may need to be tailored to the underlying substrate. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Antonios P Antoniadis; Jonathan M Behar; Simon Claridge; Tom Jackson; Manav Sohal; Christopher Aldo Rinaldi Journal: Curr Cardiol Rep Date: 2016-07 Impact factor: 2.931
Authors: Luuk I B Heckman; Marion Kuiper; Frederic Anselme; Filippo Ziglio; Nicolas Shan; Markus Jung; Stef Zeemering; Kevin Vernooy; Frits W Prinzen Journal: Heart Rhythm O2 Date: 2020-06-15
Authors: Maciej Sterliński; Adam Sokal; Radosław Lenarczyk; Frederic Van Heuverswyn; C Aldo Rinaldi; Marc Vanderheyden; Vladimir Khalameizer; Darrel Francis; Joeri Heynens; Berthold Stegemann; Richard Cornelussen Journal: PLoS One Date: 2016-04-28 Impact factor: 3.240
Authors: Steven Niederer; Cameron Walker; Andrew Crozier; Eoin R Hyde; Bojan Blazevic; Jonathan M Behar; Simon Claridge; Manav Sohal; Anoop Shetty; Tom Jackson; Christopher Rinaldi Journal: Clin Trials Regul Sci Cardiol Date: 2015-12