Optimizing Hemodynamics in Heart Failure Patients by Systematic Screening of Left Ventricular Pacing SitesThe Lateral Left Ventricular Wall and the Coronary Sinus Are Rarely the Best Sites
Nicolas Derval, MD*,*,
Paul Steendijk, PhD ,
Lorne J. Gula, MD ,
Antoine Deplagne, MD*,
Julien Laborderie, MD*,
Frederic Sacher, MD*,
Sebastien Knecht, MD*,
Matthew Wright, PhD*,
Isabelle Nault, MD*,
Sylvain Ploux, MD*,
Philippe Ritter, MD*,
Pierre Bordachar, MD*,
Stephane Lafitte, MD, PhD*,
Patricia Réant, MD*,
George J. Klein, MD,
Sanjiv M. Narayan, MD ,
Stephane Garrigue, MD*,
Mélèze Hocini, MD*,
Michel Haissaguerre, MD*,
Jacques Clementy, MD* and
Pierre Jaïs, MD*
* Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Université Bordeaux 2 Victor Segalen, Pessac, France
Leiden University Medical Center, Leiden, the Netherlands
Arrhythmia Department, University of Western Ontario, London, Ontario, Canada; and the
University of California and Veterans Affairs Medical Center, San Diego, California
View larger version (22K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Distribution of LV Pacing Sites and Catheter Position
(A) Predetermined left ventricular (LV) pacing site used during the study. The LV cavity was divided into 9 zones: 4 basal, 4 mid-cavity (inferior, lateral, anterior, and septal aspects), and 1 apex. One site was epicardial in a lateral branch of the coronary sinus (CS), and 1 site was endocardial just facing the CS pacing site. (B) Catheter position during the study.
|
|
View larger version (18K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Patient #20: Best and Worst Sites
Patient #20: +dP/dTmax recorded at the worst and best left ventricular pacing sites. AAI pacing and DDD pacing mode, long atrioventricular delay.
|
|
View larger version (18K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Best and Worst Sites for Each Individual (+dP/dTmax)
Percentage of change in +dP/dTmax for each individual patient at best (open bars) and worst (solid bars) left ventricular pacing location (long atrioventricular delay).
|
|
View larger version (38K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 Comparison of Hemodynamic Change for Both AV Delays at Best Location
AV = atrioventricular; ESP = end-systolic pressure; LAV = long atrioventricular delay; PP = pulse pressure; SAV = short atrioventricular delay.
|
|
View larger version (44K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 5 Site by Site, Mean Percentage of Change in +dP/dTmax
Mean percentage of change in +dP/dTmax for each pacing site compared with best and worst left ventricular pacing sites, long atrioventricular delay. ant = anterior; endo CS = endocardial coronary sinus; inf = inferior; lat = lateral; sept = septal.
|
|
View larger version (27K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 7 Average Hemodynamic Change at Best Site, Worst Site, and CS Site, Long AVD
Comparison of the magnitude of change of +dP/dtmax, –dP/dtmin, pulse pressure, and end-systolic pressure (ESP) at best site, worst site, and coronary sinus (CS) site, long atrioventricular delay (AVD). *p < 0.01.
|
|
View larger version (29K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 8 Impact of Left Ventricular Pacing at the Best +dP/dTmax Location
Comparison of hemodynamic change when the pacing site is defined by the site associated with the greatest improvement of +dP/dTmax. AV = atrioventricular; CS = coronary sinus; ESP = end-systolic pressure; PP = pulse pressure.
|
|
|
