title: Haemodynamic vector personalization of a quadripolar left ventricular lead used for cardiac resynchronization therapy: use of surface electrocardiogram and interventricular time delays.
abstract: OBJECTIVE
  The choice of left ventricular pacing configurations (LVPCs) of quadripolar leads used for cardiac resynchronization therapy (CRT) affects haemodynamic response and thus may be a tool for device optimization. The value of surface electrocardiograms and interventricular time delays (IVDs) for optimization is unknown.
  
  
  RESULTS
  Sixteen patients implanted with a CRT device with a quadripolar LV lead underwent invasive testing of LV dP/dt. QRS durations at baseline (bl) and during biventricular pacing (biv) were measured using different LVPCs (total of 141 LVPCs; 8.8 per patient). Variations in QRS duration during biv were calculated for each patient (ΔQRS) and, when compared with intrinsic QRS duration, for all LVPCs (ΔQRSLVPC). Interventricular time delays between the poles of the LV lead were obtained from intracardiac electrograms. ΔIVD was calculated as IVDmax - IVDmin. Parameters were correlated with LV dP/dt. ΔQRS and ΔQRSLVPC both significantly correlated with LV dP/dt (P < 0.01). Correlation was found for patients with ischaemic (P < 0.001) and non-ischaemic cardiomyopathy (P < 0.05), and for patients with bl QRS duration >168 ms (P < 0.001), but not <168 ms (P = ns). The LVPC with shortest QRS duration also yielded maximal LV dP/dt in 6 of 16 patients (37.5%), and was equal or better in LV dP/dt in 12 of 16 patients (75%). ΔIVD neither correlated with ΔQRS nor ΔLV dP/dt.
  
  
  CONCLUSIONS
  ΔQRS predicts the maximal value of vector personalization in the individual. Reductions in QRS width, but not IVDs, correlate with acute haemodynamic response. Intraindividually, in 75% of patients, the LVPC with the shortest QRS duration gives equal or superior haemodynamic results when compared with the LVPC with longest QRS duration.
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Luca
authors.initials: L
authors.lastname: Trolese
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Biermann
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Schluermann
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Faber
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany stefan.asbach@universitaets-herzzentrum.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Asbach
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D009202:Cardiomyopathies / Q000503:physiopathology*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male
keywords: Cardiac resynchronization therapy; Haemodynamics; Interventricular time delays; QRS duration; Quadripolar lead