Wouter M van Everdingen1, Alwin Zweerink2, Maarten J Cramer2, Pieter A Doevendans2, Uyên Châu Nguyên2, Albert C van Rossum2, Frits W Prinzen2, Kevin Vernooy2, Cornelis P Allaart2, Mathias Meine2. 1. From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.). w.m.vaneverdingen@umcutrecht.nl. 2. From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.).
Abstract
BACKGROUND: Previous studies indicated the importance of the intrinsic left ventricular (LV) electric delay (QLV) for optimal benefit to cardiac resynchronization therapy. We investigated the use of QLV for achieving optimal acute hemodynamic response to cardiac resynchronization therapy with a quadripolar LV lead. METHODS AND RESULTS: Forty-eight heart failure patients with a left bundle branch block were prospectively enrolled (31 men; age, 66±10 years; LV ejection fraction, 28±8%; QRS duration, 176±14 ms). Immediately after cardiac resynchronization therapy implantation, invasive LV pressure-volume loops were recorded during biventricular pacing with each separate electrode at 4 atrioventricular delays. Acute cardiac resynchronization therapy response, measured as change in stroke work (Δ%SW) compared with intrinsic conduction, was related to intrinsic interval between Q on the ECG and LV sensing delay (QLV), normalized for QRS duration (QLV/QRSd), and electrode position. QLV/QRSd was 84±9% and variation between the 4 electrodes 9±5%. Δ%SW was 89±64% and varied by 39±36% between the electrodes. In univariate analysis, an anterolateral or lateral electrode position and a high QLV/QRSd had a significant association with a large Δ%SW (all P <0.01). In a combined model, only QLV/QRSd remained significantly associated with Δ%SW (P<0.05). However, a direct relation between QLV/QRSd and Δ%SW was only seen in 24 patients, whereas 24 patients showed an inverse relation. CONCLUSIONS: The large variation in acute hemodynamic response indicates that the choice of the stimulated electrode on a quadripolar lead is important. Although QLV/QRSd was associated with acute hemodynamic response at group level, it cannot be used to select the optimal electrode in the individual patient.
BACKGROUND: Previous studies indicated the importance of the intrinsic left ventricular (LV) electric delay (QLV) for optimal benefit to cardiac resynchronization therapy. We investigated the use of QLV for achieving optimal acute hemodynamic response to cardiac resynchronization therapy with a quadripolar LV lead. METHODS AND RESULTS: Forty-eight heart failurepatients with a left bundle branch block were prospectively enrolled (31 men; age, 66±10 years; LV ejection fraction, 28±8%; QRS duration, 176±14 ms). Immediately after cardiac resynchronization therapy implantation, invasive LV pressure-volume loops were recorded during biventricular pacing with each separate electrode at 4 atrioventricular delays. Acute cardiac resynchronization therapy response, measured as change in stroke work (Δ%SW) compared with intrinsic conduction, was related to intrinsic interval between Q on the ECG and LV sensing delay (QLV), normalized for QRS duration (QLV/QRSd), and electrode position. QLV/QRSd was 84±9% and variation between the 4 electrodes 9±5%. Δ%SW was 89±64% and varied by 39±36% between the electrodes. In univariate analysis, an anterolateral or lateral electrode position and a high QLV/QRSd had a significant association with a large Δ%SW (all P <0.01). In a combined model, only QLV/QRSd remained significantly associated with Δ%SW (P<0.05). However, a direct relation between QLV/QRSd and Δ%SW was only seen in 24 patients, whereas 24 patients showed an inverse relation. CONCLUSIONS: The large variation in acute hemodynamic response indicates that the choice of the stimulated electrode on a quadripolar lead is important. Although QLV/QRSd was associated with acute hemodynamic response at group level, it cannot be used to select the optimal electrode in the individual patient.
Authors: Maciej Sterliński; Joanna Zakrzewska-Koperska; Aleksander Maciąg; Adam Sokal; Joaquin Osca-Asensi; Lingwei Wang; Vasiliki Spyropoulou; Baerbel Maus; Francesca Lemme; Osita Okafor; Berthold Stegemann; Richard Cornelussen; Francisco Leyva Journal: Front Cardiovasc Med Date: 2022-05-12
Authors: Mohammed Ali Ghossein; Francesco Zanon; Floor Salden; Antonius van Stipdonk; Lina Marcantoni; Elien Engels; Justin Luermans; Sjoerd Westra; Frits Prinzen; Kevin Vernooy Journal: J Clin Med Date: 2021-12-17 Impact factor: 4.241