TY - JOUR
T1 - Short-Term Hemodynamic and Electrophysiological Effects of Cardiac Resynchronization by Left Ventricular Septal Pacing
AU - Salden, Floor C. W. M.
AU - Luermans, Justin G. L. M.
AU - Westra, Sjoerd W.
AU - Weijs, Bob
AU - Engels, Elien B.
AU - Heckman, Luuk I. B.
AU - Lamerichs, Leon J. M.
AU - Janssen, Michel H. G.
AU - Clerx, Kristof J. H.
AU - Cornelussen, Richard
AU - Ghosh, Subham
AU - Prinzen, Frits W.
AU - Vernooy, Kevin
N1 - Funding Information:
A part of this study was financially supported by Medtronic (Minneapolis, Minnesota). Dr. Luermans has a consultancy agreement with Medtronic; and has received an educational grant from Biotronik. Dr. Engels has received a post-doctoral research fellowship from the Cardiac Arrhythmia Network of Canada (CANet). Dr. Cornelussen is an employee of Medtronic. Dr. Ghosh is an employee of and stock holder in Medtronic. Dr. Prinzen has received research grants from Medtronic, Abbott, Microport CRM, Biosense Webster, MDS, and Biotronik; and has served as an advisor to Oracle Health. Dr. Vernooy has received research grants from Medtronic, Abbott, and Biotronik; and has a consultancy agreement with Medtronic and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/2/4
Y1 - 2020/2/4
N2 - BACKGROUND Cardiac resynchronization therapy (CRT) is usually performed by biventricular (BiV) pacing. Previously, feasibility of transvenous implantation of a lead at the left ventricular (LV) endocardial side of the interventricular septum, referred to as LV septal (LVs) pacing, was demonstrated.OBJECTIVES The authors sought to compare the acute electrophysiological and hemodynamic effects of LVs with BiV and His bundle (HB) pacing in CRT patients.METHODS Temporary LVs pacing (transaortic approach) alone or in combination with right ventricular (RV) (LVs+RV), BiV, and HB pacing was performed in 27 patients undergoing CRT implantation. Electrophysiological changes were assessed using electrocardiography (QRS duration), vectorcardiography (QRS area), and multielectrode body surface mapping (standard deviation of activation times [SDAT]). Hemodynamic changes were assessed as the first derivative of LV pressure (LVdP/dtmax).RESULTS As compared with baseline, LVs pacing resulted in a larger reduction in QRS area (to 73 +/- 22 mu Vs) and SDAT (to 26 +/- 7 ms) than BiV (to 93 +/- 26 mVs and 31 +/- 7 ms; both p <0.05) and LVs+RV pacing (to 108 +/- 37 mu Vs; p <0.05; and 29 +/- 8 ms; p = 0.05). The increase in LVdP/dtmax was similar during LVs and BiV pacing (17 +/- 10% vs. 17 +/- 9%, respectively) and larger than during LVs+RV pacing (11 +/- 9%; p <0.05). There were no significant differences between basal, mid-, or apical LVs levels in LVdP/dtmax and SDAT. In a subgroup of 16 patients, changes in QRS area, SDAT, and LVdP/dtmax were comparable between LVs and HB pacing.CONCLUSIONS LVs pacing provides short-term hemodynamic improvement and electrical resynchronization that is at least as good as during BiV and possibly HB pacing. These results indicate that LVs pacing may serve as a valuable alternative for CRT. (C) 2020 by the American College of Cardiology Foundation.
AB - BACKGROUND Cardiac resynchronization therapy (CRT) is usually performed by biventricular (BiV) pacing. Previously, feasibility of transvenous implantation of a lead at the left ventricular (LV) endocardial side of the interventricular septum, referred to as LV septal (LVs) pacing, was demonstrated.OBJECTIVES The authors sought to compare the acute electrophysiological and hemodynamic effects of LVs with BiV and His bundle (HB) pacing in CRT patients.METHODS Temporary LVs pacing (transaortic approach) alone or in combination with right ventricular (RV) (LVs+RV), BiV, and HB pacing was performed in 27 patients undergoing CRT implantation. Electrophysiological changes were assessed using electrocardiography (QRS duration), vectorcardiography (QRS area), and multielectrode body surface mapping (standard deviation of activation times [SDAT]). Hemodynamic changes were assessed as the first derivative of LV pressure (LVdP/dtmax).RESULTS As compared with baseline, LVs pacing resulted in a larger reduction in QRS area (to 73 +/- 22 mu Vs) and SDAT (to 26 +/- 7 ms) than BiV (to 93 +/- 26 mVs and 31 +/- 7 ms; both p <0.05) and LVs+RV pacing (to 108 +/- 37 mu Vs; p <0.05; and 29 +/- 8 ms; p = 0.05). The increase in LVdP/dtmax was similar during LVs and BiV pacing (17 +/- 10% vs. 17 +/- 9%, respectively) and larger than during LVs+RV pacing (11 +/- 9%; p <0.05). There were no significant differences between basal, mid-, or apical LVs levels in LVdP/dtmax and SDAT. In a subgroup of 16 patients, changes in QRS area, SDAT, and LVdP/dtmax were comparable between LVs and HB pacing.CONCLUSIONS LVs pacing provides short-term hemodynamic improvement and electrical resynchronization that is at least as good as during BiV and possibly HB pacing. These results indicate that LVs pacing may serve as a valuable alternative for CRT. (C) 2020 by the American College of Cardiology Foundation.
KW - body surface mapping
KW - cardiac resynchronization therapy
KW - heart failure
KW - hemodynamics
KW - His bundle pacing
KW - ventricular septum
KW - BUNDLE-BRANCH BLOCK
KW - HIS-BUNDLE
KW - QRS DURATION
KW - THERAPY
KW - CONDUCTION
KW - MULTICENTER
KW - EXCITATION
U2 - 10.1016/j.jacc.2019.11.040
DO - 10.1016/j.jacc.2019.11.040
M3 - Article
C2 - 32000945
SN - 0735-1097
VL - 75
SP - 347
EP - 359
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -