Document Detail

Acute Hemodynamic Effect of Left Ventricular Endocardial Pacing in Cardiac Resynchronization Therapy: Assessment by Pressure-Volume Loops.
MedLine Citation:
PMID:  22589286     Owner:  NLM     Status:  Publisher    
BACKGROUND: -During cardiac resynchronization therapy (CRT) device implantation, the pacing lead is usually positioned in the coronary sinus (CS) to stimulate left ventricular (LV) epicardium. Transvenous LV endocardial pacing via transseptal puncture has been proposed as an alternative method. In this study, we evaluated the acute hemodynamic effects of CRT through LV endocardial pacing in heart failure patients by analyzing LV pressure-volume relationships. METHODS AND RESULTS: -Left ventricular pressure and volume data were determined via conductance catheter during CRT device implantation in 10 patients. In addition to the standard epicardial CS pacing, following endocardial LV sites were systematically assessed: the site transmural to the CS lead, the LV apex, the septal mid-wall, the basal and mid-lateral free wall. Four atrioventricular delays were tested. There was a significant improvement of systolic function with CRT in all LV pacing configurations, while no differences in systolic or diastolic function were detected between LV epicardial and endocardial transmural sites. The optimal pacing site varied among patients, but was rarely related to relatively longer activation delays, as assessed by analyzing endocardial electrical activation maps. Nonetheless, positioning the pacing lead at the optimal endocardial LV site in each patient significantly improved LV performance in comparison with conventional CS site stimulation (stroke volume 83 [79;112]ml versus 73 [62;89]ml, p=0.034). CONCLUSIONS: -Pacing at the optimal individual LV endocardial site yields enhanced LV performance in comparison with conventional CS site stimulation. Endocardial LV pacing might constitute an alternative approach to CRT when CS pacing is not viable.
Luigi Padeletti; Paolo Pieragnoli; Giuseppe Ricciardi; Laura Perrotta; Gino Grifoni; Maria Cristina Porciani; Vincenzo Lionetti; Sergio Valsecchi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-15
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 University of Florence, Florence & Gavazzeni Hospital, Bergamo, Italy;
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