The Hemodynamic Effect of Intrinsic Conduction During Left Ventricular Pacing as Compared to Biventricular Pacing
Berry M. van Gelder, PhD*,
Frank A. Bracke, MD, PhD,
Albert Meijer, MD, PhD and
Nico H.J. Pijls, MD, PhD
Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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Figure 1 Screen of the RadiAnalyzer Physio monitor used for measurement of left ventricular (LV) pressure and maximum rate of left ventricular pressure rise (LVdP/dtmax). Upper tracing is LV pressure, lower tracing is LVdP/dtmax. Instantaneous values and average values are displayed on the right side of the tracings. Left lower panel provides information about lead positions, pacing state, AV interval, V-V interval, and stimulation rate. Right lower panel provides a chronologic overview of measured parameters. Notice in the time column that the time elapsed between 14 measurements, 4 right ventricular (RV), 5 left ventricular (LV), and 5 biventricular (BiV) is 7 min. The LVdP/dtmax for RV, LV, and BiV pacing is 674, 851, and 782 mm Hg/s, respectively.
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Figure 2 Electrocardiogram during left ventricular (LV) pacing, showing fusion at AV1 but not at AV2, AV3, and AV4. From the electrocardiographic leads I, II, III, aVR, aVL, aVF, and V1 are displayed together with telemetered right ventricular (RV) electrogram (EGM). Notice the change in the morphology of the RV EGM when fusion is lost completely; see also Figure 3.
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Figure 3 Electrocardiogram during left ventricular (LV) pacing, showing fusion at AV1 and AV2 but not at AV3 and AV4. The right ventricular (RV) electrogram (EGM) is now changing when AV1 is programmed to AV2 and an additional change is noticed from AV2 to AV3 and AV4. The change from AV1 to AV2 is determined by the degree of fusion and from AV2 to AV3 by the complete loss of fusion.
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