90 Invasive acute haemodynamic response to guide LV lead implantation predicts chronic remodelling in patients undergoing cardiac resynchronisation therapy

Abstract

The correlations of optimal AV delays by non-invasive (Finometer) Conclusions During acute biventricular pacing, at a fixed heart rate, changing the AV delay affects the cardiac mechanoenergetics. When an AV delay improves external cardiac work, compared to LBBB or a physiologically too short AV delay (eg, AV 40 ms), it also increases the myocardial oxygen consumption. However, only 1% more energy is consumed per 1.6% more external work (pressure3flow) done; as a result cardiac efficiency improves. Haemodynamic optimisation of AV delay can be achieved with high precision using non invasive beat-to-beat pressure measurements. This should enable routine haemodynamic optimisation (easily automated) of CRT devices in clinical practice.

The Acute Hemodynamic Response to LV Pacing within Individual Branches of the Coronary Sinus using a Quadripolar Lead

“…A 10% improvement in cardiac index has previously been used to define responders 6 and this cut‐off for improvement in dP/dt max . was chosen as it has been shown to be a sensitive and specific predictor of likely reverse remodeling following CRT 21 (see Figure 5). Five patients did not respond in any CS position and four patients responded in every CS position tested.…”

“…For the same reason, the study was limited to the acute hemodynamic effects of LV pacing as compared to BiV pacing. Previous studies have demonstrated the non‐inferiority of DDDLV pacing compared to DDDBIV pacing, 16,22 however, and recent work suggests that a dP/dt max rise of >10% using DDDLV pacing at CRT implant predicts reverse remodeling at 6 months 21 …”

A review of multisite pacing to achieve cardiac resynchronization therapy

“…Many of the studies stated use acute haemodynamic data; the link, however, between acute haemodynamic measures and long-term outcome is not yet proven. 27,85 Whether MSP will translate into longer-term clinical benefits is a yet unknown and will require the results of large ongoing studies to see if such treatment may offer benefit above and beyond conventional CRT.…”

“…In most studies, the great cardiac vein 41 or inferior/anterolateral veins 7,28,32 were used for the second LV lead in addition to the standard posterior-lateral vein placement. The optimal placement of the LV lead varies between individuals 25,27 and dual-vein LV lead pacing may be viewed as an attempt to overcome the target site selection process by addressing multiple accessible sites.…”