title: Improvement of Right Ventricular Hemodynamics with Left Ventricular Endocardial Pacing during Cardiac Resynchronization Therapy.
abstract: Cardiac resynchronization therapy (CRT) with biventricular epicardial (BV-CS) or endocardial left ventricular (LV) stimulation (BV-EN) improves LV hemodynamics. The effect of CRT on right ventricular function is less clear, particularly for BV-EN. Our objective was to compare the simultaneous acute hemodynamic response (AHR) of the right and left ventricles (RV and LV) with BV-CS and BV-EN in order to determine the optimal mode of CRT delivery.
  
  
  
  Nine patients with previously implanted CRT devices successfully underwent a temporary pacing study. Pressure wires measured the simultaneous AHR in both ventricles during different pacing protocols. Conventional epicardial CRT was delivered in LV-only (LV-CS) and BV-CS configurations and compared with BV-EN pacing in multiple locations using a roving decapolar catheter.
  
  
  
  Best BV-EN (optimal AHR of all LV endocardial pacing sites) produced a significantly greater RV AHR compared with LV-CS and BV-CS pacing (P < 0.05). RV AHR had a significantly increased standard deviation compared to LV AHR (P < 0.05) with a weak correlation between RV and LV AHR (Spearman rs = -0.06). Compromised biventricular optimization, whereby RV AHR was increased at the expense of a smaller decrease in LV AHR, was achieved in 56% of cases, all with BV-EN pacing.
  
  
  
  BV-EN pacing produces significant increases in both LV and RV AHR, above that achievable with conventional epicardial pacing. RV AHR cannot be used as a surrogate for optimizing LV AHR; however, compromised biventricular optimization is possible. The beneficial effect of endocardial LV pacing on RV function may have important clinical benefits beyond conventional CRT.
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Eoin R
authors.initials: ER
authors.lastname: Hyde
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Behar
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Crozier
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Claridge
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Gill
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'Neill
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Reza
authors.initials: R
authors.lastname: Razavi
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Niederer
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D004699:Endocardium; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: biventricular acute hemodynamic response; cardiac resynchronization therapy; endocardial pacing; ventricular contractility