Does RV lead positioning provide additional benefit to cardiac resynchronization therapy in patients with advanced heart failure?
OBJECTIVE
The left ventricular (LV) stimulation site is currently recommended to position the lead at the lateral wall. However, little is known as to whether right ventricular (RV) lead positioning is also important for cardiac resynchronization therapy. This study compared the acute hemodynamic response to biventricular pacing (BiV) at two different RV stimulation sites: RV high septum (RVHS) and RV apex (RVA).


RESULTS
Using micro-manometer-tipped catheter, LV pressure was measured during BiV pacing at RV (RVA or RVHS) and LV free wall in 33 patients. Changes in LV dP/dt(max) and dP/dt(min) from baseline were compared between RVA and RVHS. BiV pacing increased dP/dt(max) by 30.3 +/- 1.2% in RVHS and by 33.3 +/- 1.7% in RVA (P = n.s.), and decreased dP/dt(min) by 11.4 +/- 0.7% in RVHS and by 13.0 +/- 1.0% in RVA (P = n.s.). To explore the optimal combination of RV and LV stimulation sites, we assessed separately the role of RV positioning with LV pacing at anterolateral (AL), lateral (LAT), or posterolateral (PL) segment. When the LV was paced at AL or LAT, the increase in dP/dt(max) with RVHS pacing was smaller than that with RVA pacing (AL: 12.2 +/- 2.2% vs 19.3 +/- 2.1%, P < 0.05; LAT: 22.0 +/- 2.7% vs 28.5 +/- 2.2%, P < 0.05). There was no difference in dP/dt(min) between RVHS- and RVA pacing in individual LV segments.


CONCLUSIONS
RVHS stimulation has no overall advantage as an alternative stimulation site for RVA during BiV pacing. RVHS was equivalent with RVA in combination with the PL LV site, while RVA was superior to RVHS in combination with AL or LAT LV site.
Shimano
Masayuki
M
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. mshimano@med.nagoya-u.ac.jp
Inden
Yasuya
Y
Yoshida
Yukihiko
Y
Tsuji
Yukiomi
Y
Tsuboi
Naoya
N
Okada
Taro
T
Yamada
Takumi
T
Murakami
Yoshimasa
Y
Takada
Yasunobu
Y
Hirayama
Haruo
H
Murohara
Toyoaki
T
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial