Cardiac resynchronization therapy in patients with ischemic versus non-ischemic heart failure: Differential effect of optimizing interventricular pacing interval.
BACKGROUND
Whether sequential biventricular pacing provides substantial benefits over conventional simultaneous stimulation remains unclear, particularly regarding the differences between ischemic and non-ischemic patients. The purpose of this study was to evaluate the acute effect of interventricular pacing interval (V-V) optimization on left ventricular (LV) systolic performance and dyssynchrony in ischemic versus non-ischemic patients.


METHODS
Sixty-nine consecutive patients underwent cardiac resynchronization therapy. Within 3 days after implantation, V-V was optimized by measuring (every 20-millisecond interval) LV systolic performance (LV outflow-tract velocity-time-integral, LVOT VTI) and LV dyssynchrony (using tissue Doppler imaging). Optimal pacing configuration was the one achieving maximal increase in LVOT VTI.


RESULTS
Optimized sequential pacing provided a significant improvement in LVOT VTI compared to simultaneous stimulation (from 138 +/- 42 to 163 +/- 38 mm, P < .001) and was associated with a significant reduction in LV dyssynchrony (from 33 +/- 31 to 19 +/- 24 milliseconds, P < .001). The increase in LVOT VTI and LV ejection fraction after implantation was greater in non-ischemic as compared to ischemic patients (P < .001). However, V-V optimization yielded a larger improvement in LV systolic performance in ischemic patients (P = .03). Consequently, the 2 groups showed comparable response after V-V optimization. A significant correlation was observed between LV scar tissue and optimal V-V interval (r = 0.58, P < .001), with a larger extent of scar related to a larger level of LV preactivation, probably reflecting slow intra-LV conduction.


CONCLUSIONS
Optimized sequential biventricular pacing further increased LV systolic performance as compared to simultaneous stimulation, particularly in ischemic patients where the presence of a large scar was correlated with a larger LV preactivation.
Department of Cardiology, Leiden University Medical Center, The Netherlands.
Nina Ajmone
NA
Marsan
Gabe B
GB
Bleeker
Rutger J
RJ
Van Bommel
C  Jan Willem
C
Borleffs
Jan Willem
JW
Borleffs
Matteo
M
Bertini
Eduard R
ER
Holman
Ernst E
EE
van der Wall
Martin J
MJ
Schalij
Jeroen J
JJ
Bax
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods; D003326:Coronary Circulation; D003331:Coronary Vessels; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial