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Arch Cardiovasc Dis. 2014 Mar;107(3):169-77. doi: 10.1016/j.acvd.2014.03.001. Epub 2014 Apr 3.

First experience of intraoperative echocardiography-guided optimization of cardiac resynchronization therapy delivery.

Author information

1
Department of Pacing and Interventional Electrophysiology, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France. Electronic address: ghassan.moubarak@gmail.com.
2
Department of Cardiology, Haut-Lévèque Hospital, Bordeaux University Hospital, 33600 Pessac, France.
3
Department of Cardiology and Vascular Medicine, Pontchaillou University Hospital, 35000 Rennes, France.
4
Department of Pacing and Interventional Electrophysiology, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.

Abstract

BACKGROUND:

Insufficient correction of mechanical dyssynchrony is a cause of non-response to cardiac resynchronization therapy (CRT).

AIMS:

To determine if CRT delivery could be optimized during the implantation procedure by choosing the number and location of pacing sites using echocardiography guidance.

METHODS:

In patients with a QRS ≥ 150 ms or a QRS < 150 ms and criteria for mechanical dyssynchrony, the objective of the implantation procedure was to shorten the left pre-ejection interval (LPEI), measured online, by at least 10 ms compared with standard biventricular configuration, by moving the right ventricular (RV) lead at different locations and, if necessary, by adding a second RV lead.

RESULTS:

Ninety-one patients (70 men; mean age 73 ± 10 years; left ventricular [LV] ejection fraction 29 ± 10%) were included. The final pacing configuration was standard biventricular in 15 (17%) patients, optimized biventricular in 22 (24%) and triple-site ventricular in 54 (59%). LPEI was shortened by ≥ 10 ms compared with standard biventricular stimulation in 73 (80%) patients. Compared with standard biventricular pacing, the final optimized pacing configuration improved global intraventricular synchrony (decreasing LPEI from 158 ± 36 ms to 134 ± 29 ms; P<0.001), LV systolic efficiency (decreasing LPEI/LV ejection time from 0.58 ± 0.18 to 0.46 ± 0.13; P<0.001) and LV filling (increasing LV filling time/RR from 44 ± 8% to 47 ± 7%; P<0.001) and decreased mitral valve regurgitation.

CONCLUSION:

Intraoperative echocardiography-guided placement of RV lead(s) during CRT implantation is feasible and acutely improves LV synchrony compared with standard biventricular stimulation.

KEYWORDS:

Cardiac resynchronization therapy; Délai pré-éjectionnel gauche; Désynchronisation mécanique; Intraoperative echocardiography; Left pre-ejection interval; Mechanical dyssynchrony; Stimulation triple-site ventriculaire; Thérapie de resynchronisation cardiaque; Triple-site ventricular stimulation; Échocardiographie peropératoire

PMID:
24703729
DOI:
10.1016/j.acvd.2014.03.001
[Indexed for MEDLINE]
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