Luigi Padeletti1, Paolo Pieragnoli2, Giuseppe Ricciardi2, Lisa Innocenti2, Luca Checchi2, Margherita Padeletti2, Antonio Michelucci2, Francesco Picariello2, Sergio Valsecchi2. 1. From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.). lpadeletti@interfree.it. 2. From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.).
Abstract
BACKGROUND: Previous studies have investigated the role of intrinsic conduction in optimizing cardiac resynchronization therapy. We investigated the role of fusing pacing-induced activation and intrinsic conduction in cardiac resynchronization therapy by evaluating the acute hemodynamic effects of simultaneous His-bundle (HIS) and left ventricular (LV) pacing. METHODS AND RESULTS: We studied 11 patients with systolic heart failure and left bundle-branch block scheduled for cardiac resynchronization therapy implantation. On implantation, LV pressure-volume data were determined via conductance catheter. Standard leads were placed in the right atrium, at the right ventricular apex, and in a coronary vein. An additional electrode was temporarily positioned in the HIS. The following pacing configurations were systematically assessed: standard biventricular (right ventricular apex+LV), LV-only, HIS, simultaneous HIS and LV (HIS+LV). Each configuration was compared with the AAI mode at multiple atrioventricular delays (AVD). In comparison with the AAI, right ventricular apex+LV and LV-only pacing resulted in improved stroke volume (85±32 mL and 86±33 mL versus 58±23 mL; P<0.001), stroke work, maximum pressure derivative, and systolic dyssynchrony at individually optimized AVD. The optimal AVD was close to the P-H interval in the majority of patients. By contrast, HIS-LV pacing improved hemodynamic indexes at all AVD (stroke volume >76 mL at all fixed intervals and 88±31 mL at optimal interval; all P<0.001). CONCLUSIONS: Standard right ventricular apex+LV and LV-only pacing enhanced systolic function and LV synchrony at individually optimized AVD close to the measured intrinsic P-H interval. By contrast, HIS+LV pacing yielded improvements, regardless of AVD setting. These findings support the hypothesis of the crucial role of intrinsic right ventricular conduction in optimal cardiac resynchronization therapy delivery.
RCT Entities:
BACKGROUND: Previous studies have investigated the role of intrinsic conduction in optimizing cardiac resynchronization therapy. We investigated the role of fusing pacing-induced activation and intrinsic conduction in cardiac resynchronization therapy by evaluating the acute hemodynamic effects of simultaneous His-bundle (HIS) and left ventricular (LV) pacing. METHODS AND RESULTS: We studied 11 patients with systolic heart failure and left bundle-branch block scheduled for cardiac resynchronization therapy implantation. On implantation, LV pressure-volume data were determined via conductance catheter. Standard leads were placed in the right atrium, at the right ventricular apex, and in a coronary vein. An additional electrode was temporarily positioned in the HIS. The following pacing configurations were systematically assessed: standard biventricular (right ventricular apex+LV), LV-only, HIS, simultaneous HIS and LV (HIS+LV). Each configuration was compared with the AAI mode at multiple atrioventricular delays (AVD). In comparison with the AAI, right ventricular apex+LV and LV-only pacing resulted in improved stroke volume (85±32 mL and 86±33 mL versus 58±23 mL; P<0.001), stroke work, maximum pressure derivative, and systolic dyssynchrony at individually optimized AVD. The optimal AVD was close to the P-H interval in the majority of patients. By contrast, HIS-LV pacing improved hemodynamic indexes at all AVD (stroke volume >76 mL at all fixed intervals and 88±31 mL at optimal interval; all P<0.001). CONCLUSIONS: Standard right ventricular apex+LV and LV-only pacing enhanced systolic function and LV synchrony at individually optimized AVD close to the measured intrinsic P-H interval. By contrast, HIS+LV pacing yielded improvements, regardless of AVD setting. These findings support the hypothesis of the crucial role of intrinsic right ventricular conduction in optimal cardiac resynchronization therapy delivery.
Authors: Jason Payne; Ann C Garlitski; Jonathan Weinstock; Munther Homoud; Christopher Madias; N A Mark Estes Journal: J Interv Card Electrophysiol Date: 2018-08-13 Impact factor: 1.900
Authors: Nadeev Wijesuriya; Mark K Elliott; Vishal Mehta; Baldeep S Sidhu; Marina Strocchi; Jonathan M Behar; Steven Niederer; Christopher A Rinaldi Journal: Front Physiol Date: 2022-06-06 Impact factor: 4.755