Document Detail

Morphology of the RV electrogram during LV pacing is related to the hemodynamic effect in cardiac resynchronization therapy.
MedLine Citation:
PMID:  17976103     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Biventricular (BiV) pacing and left ventricular (LV) pacing both improve LV function in patients with heart failure and LV dyssynchrony. We studied the hemodynamic effect of the atrioventricular (AV) interval and the associated changes in the right ventricular (RV) electrogram (EGM) during LV pacing and compared this with the hemodynamic effect of optimized sequential BiV pacing. METHODS: In 16 patients with New York Heart Association (NYHA) class II to IV, sinus rhythm with normal AV conduction, left bundle branch block (LBBB), QRS > 130 ms, and optimal medical therapy, the changes in RV EGM during LV pacing with varying AV intervals were studied. The hemodynamic effect associated with these changes was evaluated by invasive measurement of LVdP/dt(max) and compared with the result of optimized sequential BiV pacing in the same patient. RESULTS: All patients showed electrocardiographic fusion during LV pacing. The morphology of the RV EGM showed changes in the RV activation that indicated a shift in the extent of fusion from LV pacing. These changes were associated with significant changes in LVdP/dt(max). Baseline LV dP/dt(max) was 734 +/- 177 mmHg/s, which increased to 927 +/- 202 mmHg/s (P<0.0001) with optimized LV pacing and to 920 +/- 209 mmHg/s (P<0.0001) with optimized sequential BiV pacing. CONCLUSION: The RV EGM is a proper indicator for intrinsic activation over the right bundle during LV pacing and reveals the transition to fusion in the RV EGM that is associated with a decrease in LVdP/dt(max). The hemodynamic effect of optimized LV pacing is equal to optimized sequential BiV pacing.
Berry M van Gelder; Frank A Bracke; Albert Meijer; Art Pilmeyer; Nico H J Pijls
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  30     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-02     Completed Date:  2008-04-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1381-7     Citation Subset:  IM    
Bakken Research Center, Maastricht, The Netherlands.
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MeSH Terms
Aged, 80 and over
Cardiac Output, Low / diagnosis*,  prevention & control*
Cardiac Pacing, Artificial / methods*
Electrocardiography / methods*
Middle Aged
Treatment Outcome
Ventricular Dysfunction, Left / diagnosis*,  prevention & control*
Ventricular Dysfunction, Right / diagnosis*,  prevention & control

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