Key result
Right ventricular dP/dt(max) failed to identify the optimal interventricular pacing interval compared with left ventricular dP/dt(max), with identical optimal intervals in only 27% of cases.
Why the study?
Does right ventricular contractility (RV dP/dt max) accurately identify the optimal interventricular pacing interval compared to left ventricular contractility in CRT patients?
Does right ventricular contractility (RV dP/dt max) accurately identify the optimal interventricular pacing interval compared to left ventricular contractility in CRT patients?
Right ventricular contractility (RV dP/dt max) fails to identify the optimal VV interval compared with LV dP/dt max and is not recommended for VV optimization in CRT patients.
AIMS: The aim of the present study was to assess whether right ventricular (RV) contractility can be used for optimization of the interventricular (VV) interval and to study the acute hemodynamic effect of different VV intervals on right and left ventricular (LV) contractility in patients referred for cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Intracardiac LV and RV dP/dt were measured with a 0.014-in. sensor-tipped pressure guidewire during pacing at nine different VV intervals ranging from +80 ms (LV pre-excitation) to -80 ms (RV pre-excitation) in 26 patients who received a biventricular pacemaker. No correlation was found between the optimal VV intervals identified by maximum LV dP/dt and RV dP/dt, which were identical in only seven cases (27%). Only when testing slightly broader intervals (+/-20 ms) was there a statistically significant correlation (P= 0.037) between the optimized VV intervals. In the majority of patients (58%) either LV or RV pre-excitation was superior to simultaneous pacing according to LV dP/dt(max) measurements. CONCLUSION: RV dP/dt(max) failed to identify the optimal VV interval when compared with LV dP/dt(max) and can therefore not be recommended for VV optimization in CRT patients.
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Sciaraffia et al. (2009) studied Cardiac resynchronization therapy (n=26). Optimization of interventricular interval using right ventricular contractility (RV dP/dt) vs. Optimization using left ventricular contractility (LV dP/dt) was evaluated on Correlation between optimal interventricular intervals identified by maximum LV dP/dt and RV dP/dt (p=0.037). Right ventricular dP/dt(max) failed to identify the optimal interventricular pacing interval compared with left ventricular dP/dt(max), with identical optimal intervals in only 27% of cases.
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