TY - JOUR
T1 - Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery
T2 - Acute Hemodynamic Assessment by Pressure-Volume Loops
AU - Padeletti, Luigi
AU - Pieragnoli, Paolo
AU - Ricciardi, Giuseppe
AU - Innocenti, Lisa
AU - Checchi, Luca
AU - Padeletti, Margherita
AU - Michelucci, Antonio
AU - Picariello, Francesco
AU - Valsecchi, Sergio
PY - 2016/5/1
Y1 - 2016/5/1
N2 - 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
AB - 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
KW - CRT
KW - fusion
KW - heart failure
KW - His bundle
KW - pressure volume loop
KW - resynchronization
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U2 - 10.1161/CIRCEP.115.003793
DO - 10.1161/CIRCEP.115.003793
M3 - Article
C2 - 27162032
AN - SCOPUS:84969179836
VL - 9
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
SN - 1941-3149
IS - 5
M1 - e003793
ER -