| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
|
|
|
|||||||
|
|||||||||
1 Physiology, Maastricht University, Maastricht, The Netherlands
2 Cardiology, Otto-von-Guericke-University, Magdeburg, Germany
3 Cardiac Research Management, Guidant Corporation, St. Paul, MN, USA
* To whom correspondence should be addressed. E-mail: frits.prinzen{at}fys.unimaas.nl.
Objective: To explore the use of interventricular asynchrony (interVA) for optimizing cardiac resynchronization therapy (CRT), an idea emerging from a simple pathway model of conduction in the ventricles. Methods: Measurements were performed in 6 dogs with chronic left bundle branch block (LBBB) and in 29 patients of the PATH-CHF-I study. In the dogs intraventricular asynchrony (intraVA) was determined using LV endocardial activation maps. In dogs and patients LVdP/dt|max, pulse pressure (PP) and interVA (time delay between upslope of LV and RV pressure curves) were measured during left (LV), right (RV) and bi-ventricular (BiV) pacing with various atrioventricular (AV-)delays. Results: Measurements in the canine hearts supported the pathway model in that optimal resynchronization occurred at ~50% reduction of intraVA and at an interVA value halfway that during LBBB and LV pacing. In patients with significant hemodynamic response during pacing (n=22) intrinsic interVA and interVA at peak improvement (interVAp) varied widely between patients (from -83ms to -15ms and from -42ms to +31ms, respectively). However, the model predicted individual interVAp accurately (SD ±6ms and ±12 ms for LVdP/dt|max and PP, respectively). At equal interVA, LV and BiV pacing produced equal hemodynamic response, but in 11/22 responders BiV pacing reduced interVA insufficiently to reach the maximum hemodynamic response. LV pacing at short AV-delay proved to result in better hemodynamics than predicted by the model, indicating that additional factors determine hemodynamics during LV pre-excitation. Conclusions: Guided by a simple pathway model, interVA measurements accurately predict optimal hemodynamic performance in individual CRT patients.
This article has been cited by other articles:
|
|
 |
|
  M. O. Sweeney and F. W. Prinzen Ventricular Pump Function and Pacing: Physiological and Clinical Integration Circ Arrhythm Electrophysiol, June 1, 2008; 1(2): 127 - 139. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Yoshida, Y. Yokoyama, Y. Seo, Y. Sekiguchi, and K. Aonuma Triangle ventricular pacing in a non-responder to conventional bi-ventricular pacing Europace, April 1, 2008; 10(4): 502 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Butter and G. Hindricks Cardiac resynchronization therapy: haemodynamic background and perspectives Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I87 - I93. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Johnson, H. K. Kim, M. Tanabe, J. Gorcsan, D. Schwartzman, S. G. Shroff, and M. R. Pinsky Differential effects of left ventricular pacing sites in an acute canine model of contraction dyssynchrony Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H3046 - H3055. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Vernooy, R. N.M. Cornelussen, X. A.A.M. Verbeek, W. Y.R. Vanagt, A. van Hunnik, M. Kuiper, T. Arts, H. J.G.M. Crijns, and F. W. Prinzen Cardiac resynchronization therapy cures dyssynchronopathy in canine left bundle-branch block hearts Eur. Heart J., September 1, 2007; 28(17): 2148 - 2155. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
| Visit Other APS Journals Online |
