title: Clinical and procedural characteristics of acute hemodynamic responders undergoing triple-site ventricular pacing for advanced heart failure.
abstract: The advantages of triple-site ventricular pacing (Tri-V) compared to conventional biventricular site pacing (Bi-V) have been reported. We sought to identify the predictors of acute hemodynamic Tri-V responders. Acute hemodynamic studies were performed in 32 patients with advanced heart failure during Tri-V implantation. After the right ventricular (RV) and left ventricular (LV) leads were implanted for a conventional Bi-V system, an additional pacing lead was implanted in the RV outflow tract for Tri-V. The LV peak +dP/dt and tau were measured during AAI, Bi-V, and Tri-V pacing. A Tri-V responder was defined as a patient whose percentage of increase in the peak +dP/dt during Tri-V was >10% compared to of that during Bi-V. The baseline clinical variables and RV outflow tract lead location were analyzed to identify the characteristics of the Tri-V responders. Of the 32 patients, 10 (31%) were classified as Tri-V responders. The LV end-diastolic volume was greater (246 ± 48 vs 173 ± 53 ml, p <0.01), and the RV outflow tract lead was implanted at a greater outflow tract portion (p <0.05) in the Tri-V responders. Multivariate analysis revealed that only the baseline LV end-diastolic volume (per 50-ml greater) predicted the Tri-V response (odds ratio 2.87, 95% confidence interval 1.03 to 8.00, p <0.05). The area under the receiver operating characteristic curve for the LV end-diastolic volume was 0.84 (p <0.01) and an LV end-diastolic volume of >212 ml had a sensitivity of 80% and specificity of 77% to distinguish Tri-V responders. In conclusion, Tri-V provides greater hemodynamic effect for patients with a larger LV end-diastolic volume owing to its resynchronization effects on the LV anterior wall.
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Ibaraki, Japan.
authors.forename: Hiro
authors.initials: H
authors.lastname: Yamasaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Seo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Takanori
authors.initials: T
authors.lastname: Arimoto
authors.forename: Miyako
authors.initials: M
authors.lastname: Igarashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Machino
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshida
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Murakoshi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ishizu
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D003971:Diastole / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D002316:Cardiotonic Agents