Left ventricular pacing site-timing optimization during biventricular pacing using a multi-electrode patch.
A 71-year-old man with class IV congestive heart failure and an infected pacemaker/implantable cardioverter defibrillator (ICD) underwent median sternotomy for removal of endocardial leads with a 15-mm vegetation. Cardiac output during biventricular pacing was optimized with an aortic flow probe, a multi-electrode left ventricular patch, and a randomized protocol assessing 54 combinations of pacing site and right ventricle-left ventricle delay. Results that were assessed with response surface methodology determined permanent epicardial lead position and timing. The difference between the best and worst site-timing combinations altered cardiac index by nearly 70%. This experience demonstrates potential importance of the epicardial approach to site-timing optimization for biventricular pacing.
Berberian
George
G
Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
Cabreriza
Santos E
SE
Quinn
Thomas Alexander
TA
Garofalo
Cara A
CA
Spotnitz
Henry M
HM
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable; D020878:Device Removal; D004567:Electrodes, Implanted; D006333:Heart Failure / Q000150:complications; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000150:complications / Q000628:therapy