Contribution to the V-V interval optimization in patients with cardiac resynchronization therapy.
The present study proposed procedure for predicting an optimal left and right ventricular pacing interval delay (V-V interval). In 16 patients (heart failure, left bundle branch block, biventricular pacing) two methods (A and B) identifying optimal V-V interval were tested. Method A: predicted optimal V-V interval A (POVV-A) = electromechanical delay of the segment paced by left ventricle lead minus electromechanical delay of the segment paced by right ventricle lead. Method B: predicted optimal V-V interval B (POVV-B) = difference in the onset of aortic and pulmonary flows. Both methods were validated using echocardiography and right-sided heart catheterization. Cardiac output during POVV-A (4.6 l.min(-1)) was significantly better than that during POVV-A minus 20 ms (4.3 l.min(-1), p<0.01) and POVV-A plus 20 ms (4.3 l.min(-1), p<0.01), and than that during POVV-B (4.4 l.min(-1), p<0.05). LV dP/dt during POVV-A (818 mm Hg.s(-1), exceeded that during POVV-A plus 20 ms (717 mm Hg.s(-1),, p<0.05) and POVV-A minus 20 ms (681 mm Hg.s(-1), p<0.05), and that during POVV-B (727 mm Hg.s(-1), p<0.01). The time difference in onsets of myocardial deformation of left ventricle segment paced by the left ventricle and right ventricle lead allows identifying the optimal V-V interval and improves left ventricle performance.
Novák
M
M
First Clinic of Internal Medicine (Cardiology and Angiology), Faculty Hospital St. Ann, Brno, Czech Republic. miroslav.novak@fnusa.cz
Lipoldová
J
J
Meluzín
J
J
Krejčí
J
J
Hude
P
P
Feitová
V
V
Dusek
L
L
Kamarýt
P
P
Vítovec
J
J
D000200:Action Potentials; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013997:Time Factors; D016277:Ventricular Function, Left; D017725:Ventricular Pressure