Value of right ventricular-left ventricular interlead electrical delay to predict reverse remodelling in cardiac resynchronization therapy

The INTER-V pilot study

Biagio Sassone, Luca Gabrieli, Saverio Saccà, Giulio Boggian, Antonio Fusco, Claudio Pratola, Maria Letizia Bacchi-Reggiani, Luigi Padeletti, Serge S. Barold

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Aims Few studies have systematically evaluated the value of intra-procedural parameters in predicting response to cardiac resynchronization therapy (CRT). We investigated whether intracardiac (electrogram) measurements of electrical delays between the positioned right ventricular (RV) and left ventricular (LV) leads at implantation could predict the mid-term CRT response.Methods and resultsFifty-two patients underwent CRT implantation according to standard techniques and clinical indications. The RV-LV interlead electrical delay measured during spontaneous rhythm and the difference between the pacing-induced (Δp) RV-LV interlead electrical delays measured during RV and LV pacing were defined intraoperatively using the electrical depolarizations registered at the ventricular leads on the device programmer. At 6 months, a reduction of LV end-systolic volume ≥15% was used to define CRT responders. Responders (62%), when compared with non-responders, showed a higher proportion of ischaemic aetiology (P = 0.007) and a lower value of ΔpRV-LV interlead electrical delay (22.1 ± 18.4 vs. 46.3 ± 15.0 ms, P = 0.0001). At multivariate analysis, the ΔpRV-LV interlead electrical delay was the only independent predictor of response to CRT (P = 0.001). For such a parameter, the receiving operating characteristic curve analysis identified a cut-off value of 42 ms corresponding with the highest accuracy: sensitivity 90.6; specificity 70; positive and negative predictive value 83% and 82%, respectively. Conversely, no difference was ascertained between responders and non-responders when RV-LV interlead electrical delay was measured during spontaneous rhythm (76.1 ± 28.5 vs. 89.6 ± 21.2, P = 0.078).ConclusionIntraprocedural measuring of paced RV-LV interlead electrical delay obtained during RV and LV pacing predicts mid-term CRT response.

Original languageEnglish
Pages (from-to)78-83
Number of pages6
JournalEuropace
Volume12
Issue number1
DOIs
Publication statusPublished - Jan 2010

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Cardiac Resynchronization Therapy
Cardiac Electrophysiologic Techniques
Stroke Volume
Multivariate Analysis
Sensitivity and Specificity
Equipment and Supplies

Keywords

  • Biventricular pacing
  • Cardiac resynchronization therapy
  • Electrograms
  • Heart failure
  • Pacemaker lead position
  • Pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Value of right ventricular-left ventricular interlead electrical delay to predict reverse remodelling in cardiac resynchronization therapy : The INTER-V pilot study. / Sassone, Biagio; Gabrieli, Luca; Saccà, Saverio; Boggian, Giulio; Fusco, Antonio; Pratola, Claudio; Bacchi-Reggiani, Maria Letizia; Padeletti, Luigi; Barold, Serge S.

In: Europace, Vol. 12, No. 1, 01.2010, p. 78-83.

Research output: Contribution to journalArticle

Sassone, B, Gabrieli, L, Saccà, S, Boggian, G, Fusco, A, Pratola, C, Bacchi-Reggiani, ML, Padeletti, L & Barold, SS 2010, 'Value of right ventricular-left ventricular interlead electrical delay to predict reverse remodelling in cardiac resynchronization therapy: The INTER-V pilot study', Europace, vol. 12, no. 1, pp. 78-83. https://doi.org/10.1093/europace/eup347
Sassone, Biagio ; Gabrieli, Luca ; Saccà, Saverio ; Boggian, Giulio ; Fusco, Antonio ; Pratola, Claudio ; Bacchi-Reggiani, Maria Letizia ; Padeletti, Luigi ; Barold, Serge S. / Value of right ventricular-left ventricular interlead electrical delay to predict reverse remodelling in cardiac resynchronization therapy : The INTER-V pilot study. In: Europace. 2010 ; Vol. 12, No. 1. pp. 78-83.
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abstract = "Aims Few studies have systematically evaluated the value of intra-procedural parameters in predicting response to cardiac resynchronization therapy (CRT). We investigated whether intracardiac (electrogram) measurements of electrical delays between the positioned right ventricular (RV) and left ventricular (LV) leads at implantation could predict the mid-term CRT response.Methods and resultsFifty-two patients underwent CRT implantation according to standard techniques and clinical indications. The RV-LV interlead electrical delay measured during spontaneous rhythm and the difference between the pacing-induced (Δp) RV-LV interlead electrical delays measured during RV and LV pacing were defined intraoperatively using the electrical depolarizations registered at the ventricular leads on the device programmer. At 6 months, a reduction of LV end-systolic volume ≥15{\%} was used to define CRT responders. Responders (62{\%}), when compared with non-responders, showed a higher proportion of ischaemic aetiology (P = 0.007) and a lower value of ΔpRV-LV interlead electrical delay (22.1 ± 18.4 vs. 46.3 ± 15.0 ms, P = 0.0001). At multivariate analysis, the ΔpRV-LV interlead electrical delay was the only independent predictor of response to CRT (P = 0.001). For such a parameter, the receiving operating characteristic curve analysis identified a cut-off value of 42 ms corresponding with the highest accuracy: sensitivity 90.6; specificity 70; positive and negative predictive value 83{\%} and 82{\%}, respectively. Conversely, no difference was ascertained between responders and non-responders when RV-LV interlead electrical delay was measured during spontaneous rhythm (76.1 ± 28.5 vs. 89.6 ± 21.2, P = 0.078).ConclusionIntraprocedural measuring of paced RV-LV interlead electrical delay obtained during RV and LV pacing predicts mid-term CRT response.",
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AU - Fusco, Antonio

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AB - Aims Few studies have systematically evaluated the value of intra-procedural parameters in predicting response to cardiac resynchronization therapy (CRT). We investigated whether intracardiac (electrogram) measurements of electrical delays between the positioned right ventricular (RV) and left ventricular (LV) leads at implantation could predict the mid-term CRT response.Methods and resultsFifty-two patients underwent CRT implantation according to standard techniques and clinical indications. The RV-LV interlead electrical delay measured during spontaneous rhythm and the difference between the pacing-induced (Δp) RV-LV interlead electrical delays measured during RV and LV pacing were defined intraoperatively using the electrical depolarizations registered at the ventricular leads on the device programmer. At 6 months, a reduction of LV end-systolic volume ≥15% was used to define CRT responders. Responders (62%), when compared with non-responders, showed a higher proportion of ischaemic aetiology (P = 0.007) and a lower value of ΔpRV-LV interlead electrical delay (22.1 ± 18.4 vs. 46.3 ± 15.0 ms, P = 0.0001). At multivariate analysis, the ΔpRV-LV interlead electrical delay was the only independent predictor of response to CRT (P = 0.001). For such a parameter, the receiving operating characteristic curve analysis identified a cut-off value of 42 ms corresponding with the highest accuracy: sensitivity 90.6; specificity 70; positive and negative predictive value 83% and 82%, respectively. Conversely, no difference was ascertained between responders and non-responders when RV-LV interlead electrical delay was measured during spontaneous rhythm (76.1 ± 28.5 vs. 89.6 ± 21.2, P = 0.078).ConclusionIntraprocedural measuring of paced RV-LV interlead electrical delay obtained during RV and LV pacing predicts mid-term CRT response.

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KW - Pacemaker lead position

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