A Simultaneous X-MRI and Non Contact Mapping Study of the Acute Hemodynamic Effect of Left Ventricular Endocardial and Epicardial Cardiac Resynchronization Therapy in Humans Running Title: Ginks et al:Mechanistic Insights Using Endocardial Pacing In Humans
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چکیده
Background Cardiac resynchronization therapy (CRT) utilising endocardial left ventricular (LV) pacing may be superior to conventional CRT. We studied the acute hemodynamic response to conventional CRT and LV pacing from different endocardial sites using a combined cardiac MRI and LV non-contact mapping protocol to gain insights into the underlying mechanisms. Methods and Results Fifteen patients (63±10yrs, 12 male) awaiting CRT were studied in a combined X-Ray and MRI (XMR) laboratory. Delayed enhancement Cardiac MR (DE-CMR) was performed to define areas of myocardial fibrosis. Patients underwent an electrophysiological study incorporating endocardial and epicardial LV pacing. Acute haemodynamic response was measured using a pressure wire within the LV cavity to derive LV dP/dt max. Non-contact mapping (NCM) was employed to define areas of slow conduction. There was a significant improvement in all LV pacing modes versus baseline (p<0.001). LV endocardial CRT from the best endocardial site was superior to conventional CRT with a 79.8±49.0% vs. 59.6±49.5% increase in LV dP/dt max of from baseline (p < 0.05). The hemodynamic benefits of pacing were greater when LV stimulation was performed outside of areas of slow conduction defined by NCM (p <0.001). DE-CMR was able to delineate zones of slow conduction seen with NCM in ischemic patients but was unreliable in non-ischemic patients. Conclusions Endocardial LV pacing appears superior to conventional CRT although the optimal site varies between subjects and is influenced by pacing within areas of slow conduction. DE-CMR was a poor predictor of zones of slow conduction in non-ischemic patients.
منابع مشابه
A simultaneous X-Ray/MRI and noncontact mapping study of the acute hemodynamic effect of left ventricular endocardial and epicardial cardiac resynchronization therapy in humans.
BACKGROUND Cardiac resynchronization therapy (CRT) using endocardial left ventricular (LV) pacing may be superior to conventional CRT. We studied the acute hemodynamic response to conventional CRT and LV pacing from different endocardial sites using a combined cardiac MRI and LV noncontact mapping (NCM) protocol to gain insights into the underlying mechanisms. METHODS AND RESULTS Fifteen pati...
متن کاملAcute Hemodynamic Effect of Left Ventricular Endocardial Pacing in Cardiac Resynchronization Therapy: Assessment by Pressure-Volume Loops Running title: Padeletti et al.; Left Ventricular Endocardial Pacing in CRT
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Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart failure.
Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but ~30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial and multisite epicardial [triventricular (TriV)] pacing have been proposed as alternatives to traditional LV transvenous epicardial pacing, but no study has directly compared the hemodynamic effects of these approaches. Le...
متن کاملA comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization: an acute haemodynamic and electroanatomical study.
AIMS Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) lead...
متن کاملLeft Ventricular Endocardial or Triventricular Pacing to Optimize Cardiac 1 Resynchronization Therapy in a Chronic Canine Model of Ischemic Heart
20 Background: Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure 21 but approximately 30% of patients appear to not benefit from the therapy. Left ventricular (LV) 22 endocardial and multisite epicardial (TriV) pacing have been proposed as alternatives to 23 traditional LV transvenous epicardial pacing, but no study has directly compared the 24 hemodynamic effects ...
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