title: Transesophageal left ventricular electrogram-recording and temporary pacing to improve patient selection for cardiac resynchronization.
abstract: Cardiac resynchronization therapy (CRT) with biventricular pacing (BV) is an established therapy for heart failure (HF) patients with inter- and intraventricular conduction delay. The aim of this pilot study was to test the feasibility of both transesophageal measurement of left ventricular (LV) electrical delay and transesophageal LV pacing prior to implantation, to better select patients for CRT. Esophageal TO8 Osypka catheter was perorally applied in 30 HF patients in position of maximum LV deflection to measure LV electrical delay and to study arterial pulse pressure (PP) during transesophageal bipolar LV pacing. There were 15 responders with a PP increase of a mean 65 ± 24 mmHg to 79 ± 27 mmHg (P < 0.001) and a mean LV electrical delay of 86.8 ± 33 ms. The 15 non-responders with poor PP increase of a mean 63.5 ± 23.5 mmHg to 64.1 ± 23.9 mmHg (P = 0.065) had a significantly smaller LV electrical delay of 36 ± 21 ms (P < 0.001). During a 34 ± 26 month CRT follow-up, the responders New York Heart Association (NYHA) class improved from 3.1 ± 0.35 to 2.1 ± 0.35 (P < 0.001). Determination of left ventricular electrical delay by transesophageal electrogram recording and transesophageal left ventricular pacing may be additional useful techniques to improve patient selection for CRT.
authors: Division of Cardiology, Department of Internal Medicine I, Friedrich Schiller University of Jena, Erlanger Allee 101, 07740 Jena, Germany. matthias.heinke@med.uni-jena.de
authors: Matthias
authors: M
authors: Heinke
authors: Bruno
authors: B
authors: Ismer
authors: Helmut
authors: H
authors: Kühnert
authors: Hans R
authors: HR
authors: Figulla
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects