Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery: Acute Hemodynamic Assessment by Pressure-Volume Loops

Luigi Padeletti, Paolo Pieragnoli, Giuseppe Ricciardi, Lisa Innocenti, Luca Checchi, Margherita Padeletti, Antonio Michelucci, Francesco Picariello, Sergio Valsecchi

Research output: Contribution to journalArticle

Abstract

Background - Previous studies have investigated the role of intrinsic conduction in optimizing cardiac resynchronization therapy. We investigated the role of fusing pacing-induced activation and intrinsic conduction in cardiac resynchronization therapy by evaluating the acute hemodynamic effects of simultaneous His-bundle (HIS) and left ventricular (LV) pacing. Methods and Results - We studied 11 patients with systolic heart failure and left bundle-branch block scheduled for cardiac resynchronization therapy implantation. On implantation, LV pressure-volume data were determined via conductance catheter. Standard leads were placed in the right atrium, at the right ventricular apex, and in a coronary vein. An additional electrode was temporarily positioned in the HIS. The following pacing configurations were systematically assessed: standard biventricular (right ventricular apex+LV), LV-only, HIS, simultaneous HIS and LV (HIS+LV). Each configuration was compared with the AAI mode at multiple atrioventricular delays (AVD). In comparison with the AAI, right ventricular apex+LV and LV-only pacing resulted in improved stroke volume (85±32 mL and 86±33 mL versus 58±23 mL; P76 mL at all fixed intervals and 88±31 mL at optimal interval; all P

Original languageEnglish
Article numbere003793
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number5
DOIs
Publication statusPublished - May 1 2016

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Keywords

  • CRT
  • fusion
  • heart failure
  • His bundle
  • pressure volume loop
  • resynchronization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Padeletti, L., Pieragnoli, P., Ricciardi, G., Innocenti, L., Checchi, L., Padeletti, M., Michelucci, A., Picariello, F., & Valsecchi, S. (2016). Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery: Acute Hemodynamic Assessment by Pressure-Volume Loops. Circulation: Arrhythmia and Electrophysiology, 9(5), [e003793]. https://doi.org/10.1161/CIRCEP.115.003793