title: Pressure-volume loop analysis during implantation of biventricular pacemaker/cardiac resynchronization therapy device to optimize right and left ventricular pacing sites.
abstract: OBJECTIVE
  To evaluate the clinical utility of pressure-volume loop analyses during pacemaker/implantable cardioverter defibrillator (ICD) implantations to assess the optimal right ventricular (RV) and/or left ventricular (LV) lead position.
  
  
  RESULTS
  29 patients with heart failure and chronic RV apical pacing were studied. Stroke work (SW), LV ejection fraction (LVEF), cardiac output (CO), and LV dP/dt(max) were assessed using a conductance catheter in the LV during RV apical, RV outflow tract, single-site LV, and biventricular pacing at different left-sided pacing locations. Left ventricular ejection fraction was 34.3 +/- 9.8%. Compared with baseline, RV outflow tract pacing showed a small increase of 4.0 +/- 6.4% in LV dP/dt(max) and no improvement in SW, LVEF, or CO. In the optimal biventricular configuration, SW increased 39 +/- 41%, LVEF increased 22 +/- 13%, CO increased 16 +/- 16%, and LV dP/dt(max) increased 10 +/- 11% (all P < 0.05). In 45% of the patients, the optimal LV lead position was found at a different location as the 'first choice' postero-lateral or lateral target vein.
  
  
  CONCLUSIONS
  Pressure-volume loop analysis during pacemaker/ICD implantations facilitates to determine the optimal LV pacing site. Patients with chronic RV pacing showed a significant acute improvement in LV function when LV pacing or biventricular pacing is applied.
authors.affiliation: Department of Cardiology, Isala klinieken, Groot Wezenland 20, Zwolle, The Netherlands. v.r.c.derks@isala.nl
authors.forename: Peter Paul H M
authors.initials: PP
authors.lastname: Delnoy
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: Henk Oude
authors.initials: HO
authors.lastname: Luttikhuis
authors.forename: Dick H S
authors.initials: DH
authors.lastname: Vos
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
authors.forename: Anand R
authors.initials: AR
authors.lastname: Ramdat Misier
authors.forename: Willem P
authors.initials: WP
authors.lastname: Beukema
authors.forename: Paul
authors.initials: P
authors.lastname: Steendijk
authors.forename: Norbert M
authors.initials: NM
authors.lastname: van Hemel
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology