Larger Interventricular Conduction Time Enhances Mechanical Response to Resynchronization Therapy

Abstract

An optimal acute response to CRT can be obtained by positioning the LV lead at the site associated with the maximum RV-to-LV conduction time. A significant correlation appears to exist between RV-to-LV conduction time and the improvement in systolic function with CRT.

Incremental Value of Larger Interventricular Conduction Time in Improving Cardiac Resynchronization Therapy Outcome in Patients with Different QRS Duration

“…Moreover, individual variations in the conduction delay, which may modify the site of latest activation, may influence the results . Recently, several authors have demonstrated an association between longer conduction time from the right ventricular to left ventricular (RV‐to‐LV) pacing site and positive response to CRT, thus suggesting to adopt this parameter to guide LV lead placement.…”

Extraction of a trapped pacemaker lead in a pacemaker-dependent patient

“…Physiologically, the electrical excitation radiates from the endocardium to the epicardium. Therefore, arrhythmias with an epicardial origin have a higher risk regarding the development of ventricular fibrillation or torsades [6,7]. If you pace the left ventricle from epicardium only, you must be aware of this fact.…”

Coronary sinus diverticulum: Importance, function, and treatment

“…The neck of the CS diverticulum is 5-10 mm wide, opens into the CS, and is proximal to the midcardiac vein. 25 The orifice of the diverticula ranges between 2.6 and 15 mm. The smallest and largest surface area was 0.73 cm 2 and 6.45 cm 2 , respectively.…”

“…Pacing site in cardiac resynchronization therapy (CRT) plays a crucial role for hemodynamic benefits and synchronous systolic function. 25 Left lateral wall was assumed the optimal region for lead positioning in previous studies. 28 However, it has been revealed that lateral or posterolateral branch of the CS is not suitable for all patients especially with respect to mechanical response.…”

“…In CS approach, there are limited pacing sites in left ventricle (LV). 25 Also, CS anatomy, and particularly the presence of CS diverticulum, complicated LV lead placement significantly. LV lead placement becomes more restricted in LV and CS remodeling.…”