Abstract | BACKGROUND: AIMS: To determine if CRT delivery could be optimized during the implantation procedure by choosing the number and location of pacing sites using echocardiography guidance. METHODS: In patients with a QRS ≥ 150 ms or a QRS < 150 ms and criteria for mechanical dyssynchrony, the objective of the implantation procedure was to shorten the left pre-ejection interval (LPEI), measured online, by at least 10 ms compared with standard biventricular configuration, by moving the right ventricular (RV) lead at different locations and, if necessary, by adding a second RV lead. RESULTS: Ninety-one patients (70 men; mean age 73 ± 10 years; left ventricular [LV] ejection fraction 29 ± 10%) were included. The final pacing configuration was standard biventricular in 15 (17%) patients, optimized biventricular in 22 (24%) and triple-site ventricular in 54 (59%). LPEI was shortened by ≥ 10 ms compared with standard biventricular stimulation in 73 (80%) patients. Compared with standard biventricular pacing, the final optimized pacing configuration improved global intraventricular synchrony (decreasing LPEI from 158 ± 36 ms to 134 ± 29 ms; P<0.001), LV systolic efficiency (decreasing LPEI/LV ejection time from 0.58 ± 0.18 to 0.46 ± 0.13; P<0.001) and LV filling (increasing LV filling time/RR from 44 ± 8% to 47 ± 7%; P<0.001) and decreased mitral valve regurgitation. CONCLUSION: Intraoperative echocardiography-guided placement of RV lead(s) during CRT implantation is feasible and acutely improves LV synchrony compared with standard biventricular stimulation.
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Authors | Ghassan Moubarak, Philippe Ritter, Jean-Claude Daubert, Serge Cazeau |
Journal | Archives of cardiovascular diseases
(Arch Cardiovasc Dis)
Vol. 107
Issue 3
Pg. 169-77
(Mar 2014)
ISSN: 1875-2128 [Electronic] Netherlands |
PMID | 24703729
(Publication Type: Journal Article, Observational Study)
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Copyright | Copyright © 2014 Elsevier Masson SAS. All rights reserved. |
Chemical References |
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Topics |
- Aged
- Arrhythmias, Cardiac
(diagnostic imaging, drug therapy, therapy)
- Cardiac Resynchronization Therapy
(methods)
- Cardiac Resynchronization Therapy Devices
- Cardiovascular Agents
(therapeutic use)
- Combined Modality Therapy
- Electrodes, Implanted
- Female
- Humans
- Intraoperative Care
- Male
- Middle Aged
- Prospective Studies
- Prosthesis Implantation
(methods)
- Stroke Volume
- Ultrasonography, Interventional
- Ventricular Function, Left
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