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Article: Avoidance of right ventricular pacing in cardiac resynchronization therapy improves right ventricular hemodynamics in heart failure patients

TitleAvoidance of right ventricular pacing in cardiac resynchronization therapy improves right ventricular hemodynamics in heart failure patients
Authors
Issue Date2007
PublisherWiley-Blackwell Publishing, Inc.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=1045-3873
Citation
Journal Of Cardiovascular Electrophysiology, 2007, v. 18 n. 5, p. 497-504 How to Cite?
AbstractBackground: Cardiac resynchronization therapy (CRT) applied by pacing the left and right ventricles (BiV) has been shown to provide synchronous left ventricular (LV) contraction in heart failure patients. CRT may also be accomplished through synchronization of a properly timed LV pacing impulse with intrinsically conducted activation wave fronts. Elimination of right ventricular (RV) pacing may provide a more physiological RV contraction pattern and reduce device current drain. We evaluated the effects of LV and BiV pacing over a range of atrioventricular intervals on the performance of both ventricles. Methods: Acute LV and RV hemodynamic data from 17 patients with heart failure (EF = 30 ± 1%) and a wide QRS (138 ± 25 msec) or mechanical dyssynchrony were acquired during intrinsic rhythm, BiV, and LV pacing. Results: The highest LV dP/dtmax was achieved during LV pre- (LV paced prior to an RV sense) and BiV pacing, followed by that obtained during LV post-pacing (LV paced after an RV sense) and the lowest LV dP/dtmax was recorded during intrinsic rhythm. Compared with BiV pacing, LV pre-pacing significantly improved RV dP/dtmax (378 ± 136 mmHg/second vs 397 ± 136 mmHg/second, P < 0.05) and preserved RV cycle efficiency (61.6 ± 14.6% vs 68.6 ± 11.4%, P < 0.05) and stroke volume (6.6 ± 4.4 mL vs 9.0 ± 6.3 mL, P < 0.05). Based on LV dP/dtmax, the optimal atrioventricular interval could be estimated by subtracting 30 msec from the intrinsic atrial to sensed RV interval. Conclusions: Synchronized LV pacing produces acute LV and systemic hemodynamic benefits similar to BiV pacing. LV pacing at an appropriate atrioventricular interval prior to the RV sensed impulse provides superior RV hemodynamics compared with BiV pacing. © 2007 by Futura Publishing Company, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/78300
ISSN
2015 Impact Factor: 3.097
2015 SCImago Journal Rankings: 1.863
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLee, KLen_HK
dc.contributor.authorBurnes, JEen_HK
dc.contributor.authorMullen, TJen_HK
dc.contributor.authorHettrick, DAen_HK
dc.contributor.authorTse, HFen_HK
dc.contributor.authorLau, CPen_HK
dc.date.accessioned2010-09-06T07:41:22Z-
dc.date.available2010-09-06T07:41:22Z-
dc.date.issued2007en_HK
dc.identifier.citationJournal Of Cardiovascular Electrophysiology, 2007, v. 18 n. 5, p. 497-504en_HK
dc.identifier.issn1045-3873en_HK
dc.identifier.urihttp://hdl.handle.net/10722/78300-
dc.description.abstractBackground: Cardiac resynchronization therapy (CRT) applied by pacing the left and right ventricles (BiV) has been shown to provide synchronous left ventricular (LV) contraction in heart failure patients. CRT may also be accomplished through synchronization of a properly timed LV pacing impulse with intrinsically conducted activation wave fronts. Elimination of right ventricular (RV) pacing may provide a more physiological RV contraction pattern and reduce device current drain. We evaluated the effects of LV and BiV pacing over a range of atrioventricular intervals on the performance of both ventricles. Methods: Acute LV and RV hemodynamic data from 17 patients with heart failure (EF = 30 ± 1%) and a wide QRS (138 ± 25 msec) or mechanical dyssynchrony were acquired during intrinsic rhythm, BiV, and LV pacing. Results: The highest LV dP/dtmax was achieved during LV pre- (LV paced prior to an RV sense) and BiV pacing, followed by that obtained during LV post-pacing (LV paced after an RV sense) and the lowest LV dP/dtmax was recorded during intrinsic rhythm. Compared with BiV pacing, LV pre-pacing significantly improved RV dP/dtmax (378 ± 136 mmHg/second vs 397 ± 136 mmHg/second, P < 0.05) and preserved RV cycle efficiency (61.6 ± 14.6% vs 68.6 ± 11.4%, P < 0.05) and stroke volume (6.6 ± 4.4 mL vs 9.0 ± 6.3 mL, P < 0.05). Based on LV dP/dtmax, the optimal atrioventricular interval could be estimated by subtracting 30 msec from the intrinsic atrial to sensed RV interval. Conclusions: Synchronized LV pacing produces acute LV and systemic hemodynamic benefits similar to BiV pacing. LV pacing at an appropriate atrioventricular interval prior to the RV sensed impulse provides superior RV hemodynamics compared with BiV pacing. © 2007 by Futura Publishing Company, Inc.en_HK
dc.languageengen_HK
dc.publisherWiley-Blackwell Publishing, Inc.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=1045-3873en_HK
dc.relation.ispartofJournal of Cardiovascular Electrophysiologyen_HK
dc.subject.meshCardiac Pacing, Artificial - methodsen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHeart Failure - complications - prevention & controlen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshTreatment Outcomeen_HK
dc.subject.meshVentricular Dysfunction, Left - etiology - prevention & controlen_HK
dc.subject.meshVentricular Dysfunction, Right - etiology - prevention & controlen_HK
dc.titleAvoidance of right ventricular pacing in cardiac resynchronization therapy improves right ventricular hemodynamics in heart failure patientsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1045-3873&volume=18&issue=5&spage=497&epage=504&date=2007&atitle=Avoidance+of+right+ventricular+pacing+in+cardiac+resynchronization+therapy+improves+right+ventricular+hemodynamics+in+heart+failure+patientsen_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1540-8167.2007.00788.xen_HK
dc.identifier.pmid17428272-
dc.identifier.scopuseid_2-s2.0-34247511662en_HK
dc.identifier.hkuros126512en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34247511662&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume18en_HK
dc.identifier.issue5en_HK
dc.identifier.spage497en_HK
dc.identifier.epage504en_HK
dc.identifier.isiWOS:000245942200011-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLee, KL=7501505962en_HK
dc.identifier.scopusauthoridBurnes, JE=6603873393en_HK
dc.identifier.scopusauthoridMullen, TJ=7006558156en_HK
dc.identifier.scopusauthoridHettrick, DA=7007092525en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridLau, CP=35275317200en_HK
dc.identifier.citeulike1257369-

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