Document Detail


Clinical implication of right ventricular to left ventricular interlead sensed electrical delay in cardiac resynchronization therapy.
MedLine Citation:
PMID:  22308084     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AimsTo evaluate the clinical implication of right ventricular (RV) to left ventricular (LV) interlead sensed electrical delay (RV-LVs) and the relation to ventricular lead position in cardiac resynchronization therapy (CRT).Methods and ResultsEighty-five consecutive CRT patients (mean age 66 ± 11 years) received LV lead prospectively targeted to the latest mechanical activated segment (concordant), assessed by two-dimensional speckle tracking radial strain (ST-RS) echocardiography. The RV lead was randomized to RV apex (n= 43) or RV high posterior septum (n= 42). Right ventricular to left ventricular interlead sensed electrical delay was obtained during the CRT implant procedure. Intraventricular dyssynchrony was evaluated by ST-RS echocardiography. Interventricular mechanical delay (IVMD) was measured by using pulse-wave Doppler. Separated by the median RV-LVs (82 ms), a long RV-LVs demonstrated more LV end-systolic volume (LVESV) reduction than a short RV-LVs (-27 ± 20 vs. -16 ± 22%; P= 0.02), 6 months after CRT (6FU). Right ventricular to left ventricular interlead sensed electrical delay correlated to IVMD (r = 0.50; P< 0.001) and intraventricular dyssynchrony (r = 0.25; P= 0.02) at baseline. Concordant LV leads (n= 61) demonstrated superior reduction of LVESV (P= 0.005) 6 months after CRT; however, both RV lead positions had similar effects. Right ventricular to left ventricular interlead sensed electrical delay was irrespective to LV lead concordance and RV lead position (P= ns). Independent predictors to reverse remodelling (reduction of LVESV ≥15%) at 6FU were concordant LV lead (odds ratio, 3.210; P= 0.029) and IVMD (odds ratio, 1.028; P= 0.026).ConclusionRight ventricular to left ventricular interlead sensed electrical delay was not predictive to LV reverse remodelling affected by CRT at 6FU. Concordant LV leads demonstrated superior LV reverse remodelling at 6FU. Right ventricular to left ventricular interlead sensed electrical delay was irrespective of ventricular lead position and might be insufficient to target optimal LV lead position in CRT.Trial registration: http://clinicaltrials.gov. Unique identifier: NCT01035489.
Authors:
Hans Morten Kristiansen; Thomas Hovstad; Gaute Vollan; Haavard Keilegavlen; Svein Faerestrand
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-2
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
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