Biventricular pacing at the most delayed right ventricular site significantly improved LV dp/dt compared to conventional right ventricular apical pacing (30±20% vs 15±15%, p<0.05).
Does biventricular pacing at the most delayed RV site guided by CARTO improve hemodynamic parameters compared to conventional RV apical pacing in patients indicated for CRT?
Pacing at the most delayed right ventricular site (often the mid-septum) guided by electroanatomical mapping significantly improves acute hemodynamic performance compared to conventional right ventricular apical pacing during CRT.
Absolute Event Rate: 30% vs 15%
p-value: p=<0.05
BACKGROUND: The optimal left ventricle (LV) pacing site for cardiac resynchronization therapy (CRT) has been investigated, but less is known about the optimal site in the right ventricle (RV). The present study examined whether electrical resynchronization guided by electroanatomical mapping (CARTO) results in mechanical resynchronization. METHODS AND RESULTS: The study group included 13 patients indicated for CRT: 10 with nonischemic cardiomyopathy, 2 with ischemic cardiomyopathy and 1 with cardiac sarcoidosis, (mean LV ejection fraction: 32+/-10%). CARTO of the RV septum was performed to identify the site with the most delayed conduction time during LV pacing. Hemodynamic measurements were performed during conventional biventricular pacing with the RV apex and LV (C-BVP) and during biventricular pacing with the most delayed site of the RV (d-RV) and LV (D-BVP). Lead placement at 15 coronary sinus veins was examined in the 13 patients. During pacing from anterolateral veins (n=2), the d-RV was the RV apex (RVA) in 1 patient and the mid-septum in the other. During pacing from lateral veins (n=9), the d-RV comprised the RVA (n=3), the mid-septum (n=5), and the right ventricular outflow tract (RVOT) (n=1). During pacing from the posterolateral veins (n=3), the d-RV was the RVOT in all cases. In 11 of 15 sites, d-RV differed from conventional RVA. Compared with C-BVP, D-BVP produced a significant improvement in LV dp/dt. Furthermore, RV mid-septum and LV pacing markedly increased LV dp/dt and pulse pressure (PP), but RVOT and LV pacing did not. D-BVP vs C-BVP: %LV dp/dt 30+/-20 and 15+/-15%, p<0.05; RV mid-septum and LV pacing vs C-BVP: %LV dp/dt 35+/-20 and 10+/-15%, p<0.02, and vs PP 33+/-20 and 10+/-29 mmHg, p<0.02. CONCLUSIONS: For pacing from the LV lateral vein, potential improvement of cardiac performance compared with that by conventional RVA placement may be realized with concomitant pacing from the d-RV (mid-septum).
Kiuchi et al. (Mon,) conducted a other in Patients indicated for CRT (n=13). Biventricular pacing with the most delayed site of the RV (d-RV) and LV (D-BVP) vs. Conventional biventricular pacing with the RV apex and LV (C-BVP) was evaluated on %LV dp/dt (p=<0.05). Biventricular pacing at the most delayed right ventricular site significantly improved LV dp/dt compared to conventional right ventricular apical pacing (30±20% vs 15±15%, p<0.05).