Key result
In patients with heart failure and chronic AF, increasing stimulation rates produced greater increases in LV dP/dt(max) during biventricular compared to univentricular pacing.
Why the study?
Does optimized sequential biventricular pacing at varying stimulation rates improve LV dP/dt(max) compared to other pacing modalities in patients with heart failure and chronic atrial fibrillation?
Does optimized sequential biventricular pacing at varying stimulation rates improve LV dP/dt(max) compared to other pacing modalities in patients with heart failure and chronic atrial fibrillation?
In patients with heart failure and chronic atrial fibrillation, increasing stimulation rates during CRT improves acute hemodynamic response, and the optimal V-V interval decreases at higher rates.
Answers are grounded in this paper and cite their sources.
Should not change CRT programming in HF with chronic AF; leaves open whether rate-optimized biventricular pacing improves outcomes.
BACKGROUND: Optimization of cardiac resynchronization therapy (CRT) with respect to the interventricular (V-V) interval is mainly limited to pacing at a resting heart rate. We studied the effect of higher stimulation rates with univentricular and biventricular (BiV) pacing modes including the effect of the V-V interval optimization. METHODS: In 36 patients with heart failure and chronic atrial fibrillation (AF), the effects of right ventricular (RV), left ventricular (LV), simultaneous BiV, and optimized sequential BiV (BiVopt) pacing were measured. The effect of the pacing mode and the optimal V-V interval was determined at stimulation rates of 70, 90, and 110 ppm using invasive measurement of the maximum rate of left ventricular pressure rise (LV dP/dt(max)). RESULTS: The average LV dP/dt (max) for all pacing modalities at stimulation rates of 70, 90, and 110 ppm was 781 +/- 176, 833 +/- 197, and 884 +/- 223 mmHg/s for RV pacing; 893 +/- 178, 942 +/- 186, and 981 +/- 194 mmHg/s for LV pacing; 904 +/- 179, 973 +/- 187, and 1052 +/- 206 mmHg/s for simultaneous BiV pacing; and 941 +/- 186, 1010 +/- 198, and 1081 +/- 206 mmHg/s for BiVopt pacing, respectively. In BiVopt pacing, the corresponding optimal V-V interval decreased from 34 +/- 29, 28 +/- 28, and21 +/- 27ms at stimulation rates of 70, 90, and 110 ppm, respectively. In two individuals, LV dP/dt(max) decreased when the pacing rate was increased from 90 to 110 ppm. CONCLUSION: In patients with AF and heart failure, LV dP/dt(max) increases for all pacing modalities at increasing stimulation rates in most, but not all, patients. The rise in LV dP/dt(max) with increasing stimulation rates is higher in biventricular (BiV and BiVopt) than in univentricular (LV and RV) pacing. The optimal V-V interval at sequential biventricular pacing decreases with increasing stimulation rates.
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Gelder et al. (2008) studied Heart failure and chronic atrial fibrillation (n=36). Biventricular pacing (BiV and BiVopt) at increasing stimulation rates vs. Univentricular (RV and LV) pacing was evaluated on Maximum rate of left ventricular pressure rise (LV dP/dt(max)). In patients with heart failure and chronic AF, increasing stimulation rates produced greater increases in LV dP/dt(max) during biventricular compared to univentricular pacing.
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