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Netherlands Heart Journal

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Open Access 01-01-2016 | Original Article

Haemodynamic evaluation of alternative left ventricular endocardial pacing sites in clinical non-responders to cardiac resynchronisation therapy

Authors: B.M. van Gelder, R. Nathoe, F.A. Bracke

Published in: Netherlands Heart Journal | Issue 1/2016

Abstract

Introduction

Non response to cardiac resynchronisation therapy (CRT) may be related to the position of the coronary sinus lead.

Methods

We studied the acute haemodynamic response (AHR) from alternative left ventricular (LV) endocardial pacing sites in clinical non-responders to CRT. AHR and the interval from QRS onset to LV sensing (Q-LV interval) from four different endocardial pacing sites were evaluated in 24 clinical non-responders. A rise in LVdP/dtmax ≥ 15 % from baseline was considered a positive AHR. We also compared the AHR from endocardial with the corresponding epicardial lead position.

Results

The implanted system showed an AHR ≥ 15 % in 5 patients. In 9 of the 19 remaining patients, AHR could be elevated to ≥ 15 % by endocardial LV pacing. The optimal endocardial pacing site was posterolateral. There was no significant difference in AHR between the epicardial and the corresponding endocardial position. The longest Q-LV interval corresponded with the best AHR in 12 out of the 14 patients with a positive AHR, with an average Q-LV/QRS width ratio of 90 %.

Conclusions

Acute haemodynamic testing may indicate an alternative endocardial pacing site with a positive AHR in clinical non-responders. The Q-LV interval is a strongly correlated with the optimal endocardial pacing site. Endocardial pacing opposite epicardial sites does not result in a better AHR.

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Title: Haemodynamic evaluation of alternative left ventricular endocardial pacing sites in clinical non-responders to cardiac resynchronisation therapy
Authors: B.M. van Gelder
R. Nathoe
F.A. Bracke
Publication date: 01-01-2016
Publisher: Bohn Stafleu van Loghum
Published in: Netherlands Heart Journal / Issue 1/2016
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI: https://doi.org/10.1007/s12471-015-0773-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Haemodynamic evaluation of alternative left ventricular endocardial pacing sites in clinical non-responders to cardiac resynchronisation therapy

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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