Dataset Information

Electrical latency predicts the optimal left ventricular endocardial pacing site: results from a multicentre international registry.

ABSTRACT:

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?50%) achieved greater increases in AHR than non-late activating tissue (LVLED?ConclusionsIdentifying 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.

SUBMITTER: Sieniewicz BJ

PROVIDER: S-EPMC6275469 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

Electrical latency predicts the optimal left ventricular endocardial pacing site: results from a multicentre international registry.

Sieniewicz Benjamin J BJ Behar Jonathan M JM Sohal Manav M Gould Justin J Claridge Simon S Porter Bradley B Niederer Steve S Gamble James H P JHP Betts Tim R TR Jais Pierre P Derval Nicolas N Spragg David D DD Steendijk Paul P van Gelder Berry M BM Bracke Frank A FA Rinaldi Christopher A CA

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 20181201 12

<h4>Aims</h4>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.<h4>Methods and results</h4>We compiled a r ...[more]

PMID: 29688340

Similar Datasets

Project description:AimsThis registry was created to describe the experience of 76 Italian centres with a large cohort of recipients of multipoint pacing (MPP) capable cardiac resynchronization therapy (CRT) devices.Methods and resultsA total of 507 patients in whom these devices had been successfully implanted were enrolled between August 2013 and May 2015. We analysed: (i) current clinical practices for the management of such patients, and (ii) the impact of MPP on heart failure clinical composite response and on the absolute change in ejection fraction (EF) at 6 months. Multipoint pacing was programmed to 'ON' in 46% of patients before discharge. Methods of optimizing MPP programming were most commonly based on either the greatest narrowing of the QRS complex (38%) or the electrical delays between the electrodes (34%). Clinical and echocardiographic follow-up data were evaluated in 232 patients. These patients were divided into two groups according to whether MPP was programmed to 'ON' (n = 94) or 'OFF' (n = 138) at the time of discharge. At 6 months, EF was significantly higher in the MPP group than in the biventricular-pacing group (39.1 ± 9.6 vs. 34.7 ± 7.6%; P < 0.001). Even after adjustments, early MPP activation remained an independent predictor of absolute increase in LVEF of ≥5% (odds ratio 2.5; P = 0.001). At 6 months, an improvement in clinical composite score was recorded in a greater proportion of patients with MPP-ON than in controls (56 vs. 38%; P = 0.009). On comparing optimal MPP and conventional vectors, QRS was also seen to have decreased significantly (P < 0.001).ConclusionThis study provides information that is essential in order to deal with the expected increase in the number of patients receiving MPP devices in the coming years. The results revealed different practices among centres, and establishing the optimal programming that can maximize the benefit of MPP remains a challenging issue. Compared with conventional CRT, MPP improved clinical status and resulted in an additional increase in EF.Clinical trial registrationhttp://www.clinicaltrial.gov/. Unique identifier: NCT02606071.

Dataset Information

Electrical latency predicts the optimal left ventricular endocardial pacing site: results from a multicentre international registry.

Aims

Methods and results

Publications

Electrical latency predicts the optimal left ventricular endocardial pacing site: results from a multicentre international registry.

Similar Datasets

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