Invasive optimization of cardiac resynchronization therapy: role of sequential biventricular and left ventricular pacing.
BACKGROUND
Aim of this invasive study was to characterize and quantify changes in left ventricular (LV) systolic function due to sequential biventricular pacing (BV) as compared to right atrial triggered simultaneous BV (BV(0)), LV, and right ventricular (RV) pacing in patients with congestive heart failure (CHF).


METHODS
In 22 CHF patients, all in sinus rhythm, temporary multisite pacing was performed prior to implantation of a permanent system. LV systolic function was evaluated invasively by the maximum rate of LV pressure increase (dP/dt(max)). Sequential BV pacing was performed with preactivation of either ventricle at 20-80 ms.


RESULTS
In comparison to RV pacing, LV and BV(0) pacing increased dP/dt(max) by 33.9 +/- 19.3% and 34.0 +/- 22.6%, respectively (P < 0.001). In 9 patients, optimized sequential BV pacing further improved dP/dt(max) by 8.5 +/- 4.8% compared to BV(0) (range 3.3-17.1, P < 0.05). In 10 patients exhibiting a PR interval < or =200 ms, LV pacing was either superior (n = 6) or equal to BV(0) pacing (n = 4). In these 10 patients, LV pacing yielded a 7.4 +/- 8.0% higher dP/dt(max) than BV(0) pacing (P < 0.05).


CONCLUSIONS
Using sequential BV pacing, generally with LV preactivation, moderate improvements in LV systolic function can be achieved in selected patients. Baseline PR interval may aid in the selection of the optimum cardiac resynchronization therapy (CRT) mode, favoring LV pacing in patients with a PR interval < or =200 ms.
Kurzidim
Klaus
K
Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany. k.kurzidim@kerckhoff-klinik.de
Reinke
Heinrich
H
Sperzel
Johannes
J
Schneider
Hans Jürgen
HJ
Danilovic
Dejan
D
Siemon
Gregor
G
Neumann
Thomas
T
Hamm
Christian W
CW
Pitschner
Heinz-Friedrich
HF
D000368:Aged; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*