PMID- 17976103
OWN - NLM
STAT- MEDLINE
DCOM- 20080401
LR  - 20071102
IS  - 0147-8389 (Print)
IS  - 0147-8389 (Linking)
VI  - 30
IP  - 11
DP  - 2007 Nov
TI  - Morphology of the RV electrogram during LV pacing is related to the hemodynamic 
      effect in cardiac resynchronization therapy.
PG  - 1381-7
AB  - BACKGROUND: Biventricular (BiV) pacing and left ventricular (LV) pacing both 
      improve LV function in patients with heart failure and LV dyssynchrony. We 
      studied the hemodynamic effect of the atrioventricular (AV) interval and the 
      associated changes in the right ventricular (RV) electrogram (EGM) during LV 
      pacing and compared this with the hemodynamic effect of optimized sequential BiV 
      pacing. METHODS: In 16 patients with New York Heart Association (NYHA) class II 
      to IV, sinus rhythm with normal AV conduction, left bundle branch block (LBBB), 
      QRS > 130 ms, and optimal medical therapy, the changes in RV EGM during LV pacing 
      with varying AV intervals were studied. The hemodynamic effect associated with 
      these changes was evaluated by invasive measurement of LVdP/dt(max) and compared 
      with the result of optimized sequential BiV pacing in the same patient. RESULTS: 
      All patients showed electrocardiographic fusion during LV pacing. The morphology 
      of the RV EGM showed changes in the RV activation that indicated a shift in the 
      extent of fusion from LV pacing. These changes were associated with significant 
      changes in LVdP/dt(max). Baseline LV dP/dt(max) was 734 +/- 177 mmHg/s, which 
      increased to 927 +/- 202 mmHg/s (P<0.0001) with optimized LV pacing and to 920 
      +/- 209 mmHg/s (P<0.0001) with optimized sequential BiV pacing. CONCLUSION: The 
      RV EGM is a proper indicator for intrinsic activation over the right bundle 
      during LV pacing and reveals the transition to fusion in the RV EGM that is 
      associated with a decrease in LVdP/dt(max). The hemodynamic effect of optimized 
      LV pacing is equal to optimized sequential BiV pacing.
FAU - van Gelder, Berry M
AU  - van Gelder BM
AD  - Bakken Research Center, Maastricht, The Netherlands. carlgr@cze.nl
FAU - Bracke, Frank A
AU  - Bracke FA
FAU - Meijer, Albert
AU  - Meijer A
FAU - Pilmeyer, Art
AU  - Pilmeyer A
FAU - Pijls, Nico H J
AU  - Pijls NH
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Pacing Clin Electrophysiol
JT  - Pacing and clinical electrophysiology : PACE
JID - 7803944
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Output, Low/*diagnosis/*prevention & control
MH  - Cardiac Pacing, Artificial/*methods
MH  - Electrocardiography/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*diagnosis/*prevention & control
MH  - Ventricular Dysfunction, Right/*diagnosis/prevention & control
EDAT- 2007/11/03 09:00
MHDA- 2008/04/02 09:00
CRDT- 2007/11/03 09:00
PHST- 2007/11/03 09:00 [pubmed]
PHST- 2008/04/02 09:00 [medline]
PHST- 2007/11/03 09:00 [entrez]
AID - PACE875 [pii]
AID - 10.1111/j.1540-8159.2007.00875.x [doi]
PST - ppublish
SO  - Pacing Clin Electrophysiol. 2007 Nov;30(11):1381-7. doi: 
      10.1111/j.1540-8159.2007.00875.x.