This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by van Gelder, B. M. Articles by Pijls, N. H.J. Search for Related Content PubMed PubMed Citation Articles by van Gelder, B. M. Articles by Pijls, N. H.J.

CLINICAL RESEARCH: PACING SCHEMES AND RESYNCHRONIZATION

The Hemodynamic Effect of Intrinsic Conduction During Left Ventricular Pacing as Compared to Biventricular Pacing

Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands

Manuscript received September 28, 2004; revised manuscript received January 26, 2005, accepted February 1, 2005.

^_* Reprint requests and correspondence: Dr. Berry M. van Gelder, Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands (Email: carlgr{at}cze.nl).

OBJECTIVES: We sought to investigate the effect of intrinsic conduction over the right bundle on the maximum rate of left ventricular pressure rise (LVdP/dt_max) during left ventricular (LV) pacing compared to biventricular (BiV) pacing.

BACKGROUND: Simultaneous BiV pacing and LV pacing both improve LV function in patients with heart failure and LV asynchrony. We studied the hemodynamic effect of intrinsic conduction leading to ventricular fusion during LV pacing.

METHODS: In 34 patients with New York Heart Association functional class III or IV, sinus rhythm with normal atrioventricular (AV) conduction, left bundle branch block, QRS >130 ms, and optimal medical therapy, LVdP/dt_max was measured invasively during LV and simultaneous BiV pacing. The AV interval was varied in four steps starting (AV1) with an AV interval 40 ms shorter than the intrinsic PQ time and decreased with 25% for each step.

RESULTS: At AV1, LVdP/dt_max was 996 ± 194 mm Hg/s for LV pacing and 960 ± 200 mm Hg/s for BiV pacing (p = 0.0009), with all patients showing ventricular fusion during LV pacing. At AV2, 21 patients had ventricular fusion with a LVdP/dt_max of 983 ± 213 mm Hg/s and 957 ± 202 mm Hg/s for LV and BiV pacing, respectively. In the remaining 13 patients without fusion these values were 919 ± 164 mm Hg/s and 957 ± 174 mm Hg/s, respectively. The difference between LV and BiV at AV2 is significantly higher when fusion is present (p = 0.01).

CONCLUSIONS: The LVdP/dt_max is higher in LV than in BiV pacing provided that LV pacing is associated with ventricular fusion caused by intrinsic activation.

Abbreviations and Acronyms   AV = atrioventricular   BiV = biventricular   CRT = cardiac resynchronization therapy   LBBB = left bundle branch block   LV = left ventricular   LVdP/dt max = maximum rate of left ventricular pressure rise   NYHA = New York Heart Association   RV = right ventricular

This article has been cited by other articles:

				R. Vatasescu, A. Berruezo, L. Mont, D. Tamborero, M. Sitges, E. Silva, J. M. Tolosana, B. Vidal, D. Andreu, and J. Brugada Midterm 'super-response' to cardiac resynchronization therapy by biventricular pacing with fusion: insights from electro-anatomical mapping Europace, December 1, 2009; 11(12): 1675 - 1682. [Abstract] [Full Text] [PDF]

				N. Derval, P. Steendijk, L. J. Gula, A. Deplagne, J. Laborderie, F. Sacher, S. Knecht, M. Wright, I. Nault, S. Ploux, et al. Optimizing Hemodynamics in Heart Failure Patients by Systematic Screening of Left Ventricular Pacing Sites: The Lateral Left Ventricular Wall and the Coronary Sinus Are Rarely the Best Sites J. Am. Coll. Cardiol., November 18, 2009; (2009) j.jacc.2009.08.045v1. [Abstract] [Full Text] [PDF]

				M. Stahlberg, M. Damgaard, P. Norsk, A. Gabrielsen, A. Sahlen, C. Linde, and F. Braunschweig Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy Europace, September 1, 2009; 11(9): 1160 - 1167. [Abstract] [Full Text] [PDF]

				S. S. Barold, A. Ilercil, and B. Herweg Echocardiographic optimization of the atrioventricular and interventricular intervals during cardiac resynchronization Europace, November 1, 2008; 10(suppl_3): iii88 - iii95. [Abstract] [Full Text] [PDF]

				T. Stanton, N. M. Hawkins, K. J. Hogg, N. E.R. Goodfield, M. C. Petrie, and J. J.V. McMurray How should we optimize cardiac resynchronization therapy? Eur. Heart J., October 2, 2008; 29(20): 2458 - 2472. [Abstract] [Full Text] [PDF]

				P. P. Delnoy, E. Marcelli, H. Oudeluttikhuis, D. Nicastia, F. Renesto, L. Cercenelli, and G. Plicchi Validation of a peak endocardial acceleration-based algorithm to optimize cardiac resynchronization: early clinical results Europace, July 1, 2008; 10(7): 801 - 808. [Abstract] [Full Text] [PDF]

				M. O. Sweeney and F. W. Prinzen Ventricular Pump Function and Pacing: Physiological and Clinical Integration Circ Arrhythm Electrophysiol, June 1, 2008; 1(2): 127 - 139. [Full Text] [PDF]

				R. K. Rao, U. N. Kumar, J. Schafer, E. Viloria, D. De Lurgio, and E. Foster Reduced Ventricular Volumes and Improved Systolic Function With Cardiac Resynchronization Therapy: A Randomized Trial Comparing Simultaneous Biventricular Pacing, Sequential Biventricular Pacing, and Left Ventricular Pacing Circulation, April 24, 2007; 115(16): 2136 - 2144. [Abstract] [Full Text] [PDF]