Short-Term Hemodynamic and Electrophysiological Effects of Cardiac Resynchronization by Left Ventricular Septal Pacing

Floor C. W. M. Salden*, Justin G. L. M. Luermans, Sjoerd W. Westra, Bob Weijs, Elien B. Engels, Luuk I. B. Heckman, Leon J. M. Lamerichs, Michel H. G. Janssen, Kristof J. H. Clerx, Richard Cornelussen, Subham Ghosh, Frits W. Prinzen, Kevin Vernooy

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Pages (from-to)347-359
Number of pages13
JournalJournal of the American College of Cardiology
Volume75
Issue number4
DOIs
Publication statusPublished - 4 Feb 2020

Keywords

  • body surface mapping
  • cardiac resynchronization therapy
  • heart failure
  • hemodynamics
  • His bundle pacing
  • ventricular septum
  • BUNDLE-BRANCH BLOCK
  • HIS-BUNDLE
  • QRS DURATION
  • THERAPY
  • CONDUCTION
  • MULTICENTER
  • EXCITATION

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