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

Shetty, Anoop; Duckett, Simon; Liang, Ying; Kapetanakis, Stamatis; Ginks, Matthew; Bostock, Julian; Carr‐White, Gerald; Rhode, Kawal; Razavi, Reza; Rinaldi, Christopher Aldo

doi:10.1111/j.1540-8159.2011.03268.x

Cited by 21 publications

(10 citation statements)

References 23 publications

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“…111 In another study, however, no acute haemodynamic improvement was observed with multipoint pacing, whereas pacing with two separate LV leads did increase LVdP/dt max . 112 Given that quadripolar leads are becoming widely available, more information is likely to be forthcoming about the possible benefits of multipoint pacing. Experiments using a canine model of LBBB did not show significantly better acute haemodynamic response to triventricular pacing than to biventricular pacing.…”

Section: Intrinsic Lbbb Versus Rv Pacingmentioning

confidence: 99%

Strategies to improve cardiac resynchronization therapy

et al. 2014

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Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.

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Section: Intrinsic Lbbb Versus Rv Pacingmentioning

confidence: 99%

Strategies to improve cardiac resynchronization therapy

et al. 2014

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“…16 The second study, carried out in 19 patients with a quadripolar lead, found significant acute hemodynamic differences, determined by invasive estimation of dP/dt max between the best and worst pacing vector. 17 In the QUARTO study, we observed that in over half of the patients the best CO was obtained with configurations only available with the quadripolar lead ("nontraditional configurations"). The variability in the vector associated with this CO suggests that there may not be a single universally optimal vector programming, making the flexibility of a quadripolar lead an attractive clinical tool.…”

Section: Discussionmentioning

confidence: 97%

“…These findings tally with those obtained in two previous studies. 16,17 The first one, carried out in 14 patients, found significant differences between four and six possible configurations in the CO (4.6 ± 1.4 L/min vs 3.9 ± 1.4 L/min; P < 0.001) and myocardial performance index (0.40 ± 0.29 vs 0.64 ± 0.48; P = 0.003). 16 The second study, carried out in 19 patients with a quadripolar lead, found significant acute hemodynamic differences, determined by invasive estimation of dP/dt max between the best and worst pacing vector.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Hemodynamic Response Using a Quadripolar LV Lead

Bueno

Rodríguez

Ros

et al. 2013

Pacing Clinical Electrophis

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“…Therefore, it is easily conceivable that studies that evaluated CRT response at different sites within single CS tributaries did not find systematic, but substantial intraindividual differences with respect to the optimal pacing site [21], [22].…”

Section: Discussionmentioning

confidence: 99%

Vector Selection of a Quadripolar Left Ventricular Pacing Lead Affects Acute Hemodynamic Response to Cardiac Resynchronization Therapy: A Randomized Cross-Over Trial

et al. 2013

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BackgroundA suboptimal left ventricular (LV) pacing site may account for non-responsiveness of patients to cardiac resynchronization therapy (CRT). The vector selection of a novel quadripolar LV pacing lead, which was mainly developed to overcome technical issues with stimulation thresholds and phrenic nerve capture, may affect hemodynamic response, and was therefore assessed in this study. (German Clinical Trials Register DRKS00000573).Methods and ResultsHemodynamic effects of a total of 145 LVPCs (9.1 per patient) of CRT devices with a quadripolar LV lead (Quartet™, St. Jude Medical) were assessed in 16/20 consecutive patients by invasive measurement of LV+dP/dtmax at an invasively optimized AV-interval in random order. Optimal (worst) LVPCs per patient were identified as those with maximal (minimal) %change in LV+dP/dtmax (%ΔLV+dP/dtmax) as compared to a preceding baseline. LV+dP/dtmax significantly increased in all 145 LVPCs (p<0.0001 compared to baseline) with significant intraindividual differences between LVPCs (p<0.0001). Overall, CRT acutely augmented %ΔLV+dP/dtmax by 31.3% (95% CI 24%–39%) in the optimal, by 21.3% (95% CI: 15%–27%) in the worst and by 28.2% (95% CI: 21%–36%) in a default distal LVPC. This resulted in an absolute additional acute increase in %ΔLV+dP/dtmax of 10.0% (95% CI: 7%–13%) of the optimal when compared to the worst (p<0.0001), and of 3.1% (95% CI: 1%–5%) of the optimal when compared to the default distal LVPC (p<0.001). Optimal LVPCs were not programmable with a standard bipolar lead in 44% (7/16) of patients.ConclusionThe pacing configuration of a quadripolar LV lead determinates acute hemodynamic response. Pacing in the individually optimized configuration gives rise to an additional absolute 10% increase in %ΔLV+dP/dtmax when comparing optimal and worst vectors.

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

Cited by 21 publications

References 23 publications

Strategies to improve cardiac resynchronization therapy

Strategies to improve cardiac resynchronization therapy

Improvement in Hemodynamic Response Using a Quadripolar LV Lead

Vector Selection of a Quadripolar Left Ventricular Pacing Lead Affects Acute Hemodynamic Response to Cardiac Resynchronization Therapy: A Randomized Cross-Over Trial

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