TY - JOUR
T1 - Electrical latency predicts the optimal left ventricular endocardial pacing site
T2 - Results from a multicentre international registry
AU - Sieniewicz, Benjamin J.
AU - Behar, Jonathan M.
AU - Sohal, Manav
AU - Gould, Justin
AU - Claridge, Simon
AU - Porter, Bradley
AU - Niederer, Steve
AU - Gamble, James H.P.
AU - Betts, Tim R.
AU - Jais, Pierre
AU - Derval, Nicolas
AU - Spragg, David D.
AU - Steendijk, Paul
AU - van Gelder, Berry M.
AU - Bracke, Frank A.
AU - Rinaldi, Christopher A.
N1 - Funding Information:
B.J.S. is supported by a British Heart Foundation Project Grant. J.G. and B.P. are supported by a clinical research fellowship programme funded by Abbott. The Oxford group were supported by the charity Heart Research UK and the UK National Institute of Health Research Oxford Biomedical Research Centre (J.H.P.G., T.R.B.). T.R.B. wold like to acknowledge that he is supported by the Oxford Biomedical Research Centre.
Funding Information:
B.J.S. is supported by a British Heart Foundation Project Grant. J.G. and B.P. are supported by a clinical research fellowship programme funded by Abbott. The Oxford group were supported by the charity Heart Research UK and the UK National Institute of Health Research Oxford Biomedical Research Centre (J.H.P.G., T.R.B.). T.R.B. wold like to acknowledge that he is supported by the Oxford Biomedical Research Centre. J.B. has received speakers Fees- Abbott. B.M.v.G. has received training and education on Pacing and CRT from St Jude Medical, is a consultant with RADI pressure wire systems, a St Jude Medical company, and consultant for Pacing and CRT with Sorin Group CRM SAS. C.A.R. has received research funding and/or consultancy fees from Abbott, Medtronic Inc., Boston Scientific, LivaNova and Spectranetics outside of the submitted work. All other authors have no conflicts to declare.
Publisher Copyright:
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Aims The optimal site for biventricular endocardial (BIVENDO) pacing remains undefined. Acute haemodynamic response (AHR) is reproducible marker of left ventricular (LV) contractility, best expressed as the change in the maximum rate of LV pressure (LV-dp/dtmax), from a baseline state. We examined the relationship between factors known to impact LV contractility, whilst delivering BIVENDO pacing at a variety of LV endocardial (LVENDO) locations. Methods and results We compiled a registry of acute LVENDO pacing studies from five international centres: Johns Hopkins-USA, Bordeaux-France, Eindhoven-The Netherlands, Oxford-United Kingdom, and Guys and St Thomas’ NHS Foundation Trust, London-UK. In all, 104 patients incorporating 687 endocardial and 93 epicardial pacing locations were studied. Mean age was 66 ± 11 years, mean left ventricular ejection fraction 24.6 ± 7.7% and mean QRS duration of 163 ± 30 ms. In all, 50% were ischaemic [ischaemic cardiomyopathy (ICM)]. Scarred segments were associated with worse haemodynamics (dp/dtmax; 890 mmHg/s vs. 982 mmHg/s, P < 0.01). Delivering BiVENDO pacing in areas of electrical latency was associated with greater improvements in AHR (P < 0.01). Stimulating late activating tissue (LVLED >50%) achieved greater increases in AHR than non-late activating tissue (LVLED < 50%) (8.6 ± 9.6% vs. 16.1 ± 16.2%, P = 0.002). However, the LVENDO pacing location with the latest Q-LV, was associated with the optimal AHR in just 62% of cases. Conclusions Identifying viable LVENDO tissue which displays late electrical activation is crucial to identifying the optimal BiVENDO pacing site. Stimulating late activating tissue (LVLED >50%) yields greater improvements in AHR however, the optimal location is frequently not the site of latest activation.
AB - Aims The optimal site for biventricular endocardial (BIVENDO) pacing remains undefined. Acute haemodynamic response (AHR) is reproducible marker of left ventricular (LV) contractility, best expressed as the change in the maximum rate of LV pressure (LV-dp/dtmax), from a baseline state. We examined the relationship between factors known to impact LV contractility, whilst delivering BIVENDO pacing at a variety of LV endocardial (LVENDO) locations. Methods and results We compiled a registry of acute LVENDO pacing studies from five international centres: Johns Hopkins-USA, Bordeaux-France, Eindhoven-The Netherlands, Oxford-United Kingdom, and Guys and St Thomas’ NHS Foundation Trust, London-UK. In all, 104 patients incorporating 687 endocardial and 93 epicardial pacing locations were studied. Mean age was 66 ± 11 years, mean left ventricular ejection fraction 24.6 ± 7.7% and mean QRS duration of 163 ± 30 ms. In all, 50% were ischaemic [ischaemic cardiomyopathy (ICM)]. Scarred segments were associated with worse haemodynamics (dp/dtmax; 890 mmHg/s vs. 982 mmHg/s, P < 0.01). Delivering BiVENDO pacing in areas of electrical latency was associated with greater improvements in AHR (P < 0.01). Stimulating late activating tissue (LVLED >50%) achieved greater increases in AHR than non-late activating tissue (LVLED < 50%) (8.6 ± 9.6% vs. 16.1 ± 16.2%, P = 0.002). However, the LVENDO pacing location with the latest Q-LV, was associated with the optimal AHR in just 62% of cases. Conclusions Identifying viable LVENDO tissue which displays late electrical activation is crucial to identifying the optimal BiVENDO pacing site. Stimulating late activating tissue (LVLED >50%) yields greater improvements in AHR however, the optimal location is frequently not the site of latest activation.
KW - Biventricular pacing/cardiac resynchronization therapy
KW - Leadless pacing
KW - Left ventricular endocardial pacing
KW - Personalized medicine
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U2 - 10.1093/europace/euy052
DO - 10.1093/europace/euy052
M3 - Article
C2 - 29688340
AN - SCOPUS:85056347133
SN - 1099-5129
VL - 20
SP - 1989
EP - 1996
JO - Europace
JF - Europace
IS - 12
ER -