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Journal of Interventional Cardiac Electrophysiology

Published in:

01-04-2013

Right ventricular lead adjustment in cardiac resynchronization therapy and acute hemodynamic response: a pilot study

Authors: Prabhat Kumar, Gaurav A. Upadhyay, Christine Cavaliere-Ogus, E. Kevin Heist, Robert K. Altman, Neal A. Chatterjee, Kimberly A. Parks, Jagmeet P. Singh

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2013

Abstract

Purpose

Optimal left ventricular (LV) lead position has emerged as an important determinant of response after cardiac resynchronization therapy (CRT). Comparatively, strategy for right ventricular (RV) lead optimization remains uncertain.

Methods

Three variations of RV lead position (apex, mid-septal, and high septal) were tested in seven consecutive patients. At each location, intra-procedural measurement of LV lead electrical delay (LVLED) was obtained during intrinsic rhythm and RV pacing (RV-LVLED). Simultaneous cardiac output assessment was performed using the LiDCO™ (lithium chloride indicator dilution) system. Final RV lead location was selected based on best-measured cardiac output. Clinical and echocardiographic outcomes were assessed at baseline and 6 months.

Results

Adjustment of RV lead position after securing a LV lead site led to an incremental change of 30 ± 18 % (range, 7–52 %) in the cardiac index (CI). There was substantial variation in acute hemodynamic response (∆CI, 14 ± 13 %; range, 3–41 %) seen with pacing from each patient’s worst to best RV lead position; no single RV lead position emerged as optimal across all patients. Paced RV-LVLED was not correlated with percent change in CI (r = 0.18; p = NS). LV ejection fraction (LVEF) increased significantly (28 ± 4 to 40 ± 8 %, p = 0.006) at 6 months. LVLED measured during intrinsic rhythm, but not during RV pacing, correlated with percent change in LVEF (r = 0.88, p = 0.02).

Conclusions

RV lead position adjustment can be used to enhance acute hemodynamic response during CRT. Measurement of paced RV-LVLED, however, does not reliably predict change in cardiac output.

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Title: Right ventricular lead adjustment in cardiac resynchronization therapy and acute hemodynamic response: a pilot study
Authors: Prabhat Kumar
Gaurav A. Upadhyay
Christine Cavaliere-Ogus
E. Kevin Heist
Robert K. Altman
Neal A. Chatterjee
Kimberly A. Parks
Jagmeet P. Singh
Publication date: 01-04-2013
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2013
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-012-9759-1

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Springer Medicine

Right ventricular lead adjustment in cardiac resynchronization therapy and acute hemodynamic response: a pilot study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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