Dual-Site Left Ventricular Cardiac Resynchronization Therapy

Luigi Padeletti, Andrea Colella, Antonio Michelucci, Paolo Pieragnoli, Giuseppe Ricciardi, Maria Cristina Porciani, Francesca Tronconi, Douglas A. Hettrick, Sergio Valsecchi

Research output: Contribution to journalArticlepeer-review

Abstract

Simultaneous stimulation of 2 left ventricular (LV) sites could enhance the effectiveness of cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the acute hemodynamic response to dual-site LV CRT. Two LV pacing leads were successfully implanted in 12 CRT candidates (New York Heart Association classes III to IV, QRS ≥120 ms). Target positions were the lateral or posterolateral vein (site A) and anterior or anterolateral vein (site B). A conductance catheter was placed in the left ventricle for pressure-volume measurements. Tested CRT configurations were alternated by atrial overdrive pacing at a fixed rate and included site A and B single-site CRT and dual-site LV CRT (2 LV sites plus right ventricular apex) at 4 atrioventricular intervals. Overall, single-site LV CRT significantly enhanced stroke volume, stroke work, maximum pressure derivative, and conductance-derived indexes of LV synchrony when delivered in site A, whereas no significant changes were noticed with pacing in site B. Specifically, site-A pacing resulted in a higher stroke volume increase (LV pacing site associated with the best hemodynamic response [best-LV]) in 8 patients, and site-B pacing, in 4 patients. At intermediate atrioventricular intervals, dual-site LV CRT resulted in improved stroke volume, stroke work, maximum pressure derivative, and LV synchrony with respect to single-site CRT when delivered at the best-LV (all p

Original languageEnglish
Pages (from-to)1687-1692
Number of pages6
JournalThe American Journal of Cardiology
Volume102
Issue number12
DOIs
Publication statusPublished - Dec 15 2008

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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