Document Detail


Optimization of the interventricular delay in cardiac resynchronization therapy using the QRS width.
MedLine Citation:
PMID:  19892059     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Optimization of the interventricular pacing delay (VV) in cardiac resynchronization therapy is time-consuming and not routinely performed. The aim of the present study was to compare the acute hemodynamic response obtained by different VV programming methods. Several methods for optimizing the VV using electrocardiographic or echocardiographic measurements were performed. The effect of programming an empirical prefixed VV of 0 ms was also evaluated. Invasive first derivative of left ventricular (LV) pressure over time (dP/dt max) was measured at several VV values, and the hemodynamic response that could be obtained by each noninvasive VV selection method was extrapolated from the curve of LV dP/dt max versus VV. The study included 25 patients (80% men, age 66 +/- 9 years, 44% ischemic). The maximum achievable LV dP/dt during biventricular pacing was obtained by a median left ventricular preactivation of 30 ms and increased the baseline unpaced LV dP/dt from 774 +/- 181 to 934 +/- 179 mm Hg/s (p <0.001). The noninvasive optimization method selected the VV leading to the narrowest QRS measured from the earliest deflection and obtained the smallest difference with regard to the maximum achievable LV dP/dt. Furthermore, of all the VV optimization methods tested, this was the only 1 that significantly improved on the hemodynamic response obtained by programming a predefined VV of 0 ms in all patients (925 +/- 178 vs 906 +/- 183 mm Hg/s; p = 0.003). In conclusion, achieving the narrowest QRS measured from the earliest deflection obtained a better acute hemodynamic response than the other VV optimization methods. It also improved the response obtained by default simultaneous biventricular pacing, although this improvement was limited in magnitude.
Authors:
David Tamborero; Lluís Mont; Marta Sitges; Etelvino Silva; Antonio Berruezo; Barbara Vidal; Victoria Delgado; Jose M Tolosana; Miguel Godoy; Angeles Castel; Josep Brugada
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  104     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-06     Completed Date:  2009-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1407-12     Citation Subset:  AIM; IM    
Affiliation:
Thorax Institute, Hospital Clinic, University of Barcelona, Institut de Investigació Biomèdica August Pi i Sunyer, Barcelona, Catalonia, Spain.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiac Pacing, Artificial / methods*
Defibrillators, Implantable
Diastole / physiology
Echocardiography, Doppler
Electrocardiogram Pattern*
Female
Heart Failure / physiopathology*,  therapy*,  ultrasonography
Humans
Male
Middle Aged
Stroke Volume / physiology
Systole / physiology
Ventricular Dysfunction, Left / physiopathology,  therapy,  ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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