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Peter Paul H.M. Delnoy, Jan Paul Ottervanger, Henk Oude Luttikhuis, Dick H.S. Vos, Arif Elvan, Anand R. Ramdat Misier, Willem P. Beukema, Paul Steendijk, Norbert M. van Hemel, Pressure–volume loop analysis during implantation of biventricular pacemaker/cardiac resynchronization therapy device to optimize right and left ventricular pacing sites, European Heart Journal, Volume 30, Issue 7, April 2009, Pages 797–804, https://doi.org/10.1093/eurheartj/ehp011
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Abstract
To evaluate the clinical utility of pressure–volume loop analyses during pacemaker/implantable cardioverter defibrillator (ICD) implantations to assess the optimal right ventricular (RV) and/or left ventricular (LV) lead position.
29 patients with heart failure and chronic RV apical pacing were studied. Stroke work (SW), LV ejection fraction (LVEF), cardiac output (CO), and LV dP/dtmax were assessed using a conductance catheter in the LV during RV apical, RV outflow tract, single-site LV, and biventricular pacing at different left-sided pacing locations. Left ventricular ejection fraction was 34.3 ± 9.8%. Compared with baseline, RV outflow tract pacing showed a small increase of 4.0 ± 6.4% in LV dP/dtmax and no improvement in SW, LVEF, or CO. In the optimal biventricular configuration, SW increased 39 ± 41%, LVEF increased 22 ± 13%, CO increased 16 ± 16%, and LV dP/dtmax increased 10 ± 11% (all P < 0.05). In 45% of the patients, the optimal LV lead position was found at a different location as the ‘first choice' postero-lateral or lateral target vein.
Pressure–volume loop analysis during pacemaker/ICD implantations facilitates to determine the optimal LV pacing site. Patients with chronic RV pacing showed a significant acute improvement in LV function when LV pacing or biventricular pacing is applied.
- artificial cardiac pacemaker
- ventricular function, left
- left ventricular ejection fraction
- cardiac output
- cerebrovascular accident
- ischemic stroke
- implantable defibrillators
- heart failure
- left ventricle
- heart ventricle
- catheters
- cardiac resynchronization therapy
- ejection fraction
- biventricular pacing devices
- implantable defibrillator insertion
- medical devices
- implantation procedure
- pressure volume loop
- right ventricular outflow function