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Right ventricular contractility as a measure of optimal interventricular pacing setting in cardiac resynchronization therapy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (Arytmi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (Arytmi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (Arytmi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (Arytmi)
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2009 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 11, no 11, 1496-1500 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim of the present study was to assess whether right ventricular (RV) contractility can be used for optimization of the interventricular (VV) interval and to study the acute hemodynamic effect of different VV intervals on right and left ventricular (LV) contractility in patients referred for cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Intracardiac LV and RV dP/dt were measured with a 0.014-in. sensor-tipped pressure guidewire during pacing at nine different VV intervals ranging from +80 ms (LV pre-excitation) to -80 ms (RV pre-excitation) in 26 patients who received a biventricular pacemaker. No correlation was found between the optimal VV intervals identified by maximum LV dP/dt and RV dP/dt, which were identical in only seven cases (27%). Only when testing slightly broader intervals (+/-20 ms) was there a statistically significant correlation (P= 0.037) between the optimized VV intervals. In the majority of patients (58%) either LV or RV pre-excitation was superior to simultaneous pacing according to LV dP/dt(max) measurements. CONCLUSION: RV dP/dt(max) failed to identify the optimal VV interval when compared with LV dP/dt(max) and can therefore not be recommended for VV optimization in CRT patients.

Place, publisher, year, edition, pages
2009. Vol. 11, no 11, 1496-1500 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-123724DOI: 10.1093/europace/eup288ISI: 000271388700019PubMedID: 19812048OAI: oai:DiVA.org:uu-123724DiVA: diva2:315555
Available from: 2010-04-29 Created: 2010-04-29 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Cardiac Resynchronization Therapy Optimization: Comparison and Evaluation of Non-invasive Methods
Open this publication in new window or tab >>Cardiac Resynchronization Therapy Optimization: Comparison and Evaluation of Non-invasive Methods
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general purpose of this thesis was to investigate new cardiac resynchronization therapy (CRT) optimization techniques and to assess their reliability when compared to invasive measurements of left ventricular contractility (LV dP/dtmax).We first assessed whether cardiac output (CO) measured by trans-thoracic impedance cardiography could correctly identify the optimal interventricular (VV) pacing interval while using invasive measurements of LV dP/dtmax as reference. We did not find any significant statistical correlation between the two optimizing methods when their corresponding optimal VV intervals were compared.

We also tested the hypothesis that measurements of right ventricular contractility (RV dP/dtmax) could be used to guide VV delay optimization in CRT. The comparison of optimal VV intervals obtained from the left and right ventricular dP/dtmax did not show a statistically significant correlation; however, a positive correlation was found when broader VV intervals were evaluated and we concluded that this finding deserves further investigation.

An interesting alternative for CRT optimization is the use of device integrated algorithms or sensors capable to adapt the CRT settings to the current needs of the individual patient. In this respect we investigated the use of cardiogenic impedance (CI) measurements obtained through the CRT-D device as a method for CRT optimization with invasive measurements of LV dP/dtmax as a reference. Our results showed that CI could be measured through the device after implantation and that a patient-specific impedance-based prediction model was capable to accurately predict the optimal AV and VV delays. To follow up on these positive results we re-evaluated the patient-specific impedance-based prediction models 24 hours post implantation and investigated the possibility of calibrating them using parameters derived from non-invasive measurements of arterial pressure obtained by finger pelthysmography at implantation.The results showed that the patient-specific impedance-based prediction models did not perform as well on the follow-up data as they did on the data from implantation day and that they correlated poorly with plethysmographic parameters.

Our studies suggest that novel methods for CRT optimization should be thoroughly evaluated and compared to established measures of left ventricular function prior to introduction into clinical practice.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 52 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 802
Keyword
cardiac resynchronization therapy, device optimization, left ventricular contractility
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-179785 (URN)978-91-554-8450-7 (ISBN)
Public defence
2012-10-05, Robergsalen, Akademiska Sjukhuset, Ing. 40, Uppsala, 13:00 (English)
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Supervisors
Available from: 2012-09-14 Created: 2012-08-22 Last updated: 2013-01-22Bibliographically approved

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