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Semi-invasive left cardiac pacing and electrocardiography – cardiac resynchronization therapy improvement can be predicted by pacing?

  • Introduction: Cardiac resynchronization therapy (CRT) with left ventricular (LV) pacing is an established therapy for heart failure (HF) patients (P) with ventricular desynchronisation and reduced LV ejection fraction (EF). The aim of this study was to test the utilization of the transesophageal approach to measure arterial pulse pressure (PP) during LV pacing and electrical interventricularIntroduction: Cardiac resynchronization therapy (CRT) with left ventricular (LV) pacing is an established therapy for heart failure (HF) patients (P) with ventricular desynchronisation and reduced LV ejection fraction (EF). The aim of this study was to test the utilization of the transesophageal approach to measure arterial pulse pressure (PP) during LV pacing and electrical interventricular conduction delay (IVCD), to better select patients for CRT. Methods: 32 HF patients (age 64 ± 10 years; 5 females, 27 males) with New York Heart Association (NYHA) class 2.8 ± 0.6, 27 ± 11 % LV EF and 155 ± 35 ms QRS duration were analysed with semi-invasive left cardiac pacing and electrocardiography. Esophageal TO8 Osypka catheter of 10.5 F diameter was perorally applied to the esophagus and placed in the position of maximum left atrial (LA) deflection and maximum LV deflection to measure PP with VAT or D00 pacing modes. Results: Temporary transesophageal LV pacing was possible with VAT mode (n=16) and D00 mode (n=16) in all patients. In 15 Δ-PP-responders, PP was higher during LV pacing on than LV pacing off (78.3 ± 26.6 versus 65.9 ± 23.7 mmHg, P < 0.001) and NYHA class improved from 3.1 ± 0.35 to 2.1 ± 0.35 (P < 0.001) during 29 ± 26 month biventricular (BV) pacing follow-up (6 Medtronic and 9 Boston BV pacing devices). In 17 Δ-PP-non-responders, PP was not higher during LV pacing on than LV pacing off (61.5 ± 23.9 versus 60.9 ± 23.5 mmHg, P = 0.066). IVCD was significant longer in Δ-PP-responders than in Δ-PP-non-responders (87 ± 33 ms versus 37± 29 ms, P < 0.001). Conclusion: Semi-invasive transesophageale LA and LV pacing with D00 and VAT mode and LV electrogram recording may be useful techniques to predict CRT improvement.show moreshow less

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Metadaten
Author:Matthias HeinkeGND, Bruno IsmerGND, Ingolf Wehsener, Helmut Kühnert, Tobias Heinke, Ralf Surber, Gudrun Dannberg, Hans Reiner Figulla
Publisher:Walter de Gruyter
Place of publication:Berlin, Boston
Date of Publication (online):2011/09/30
Pagenumber:1
Language:English
Parent Title (Multiple languages):Biomedical Engineering / Biomedizinische Technik
Volume:56
Issue:S1
ISSN:0013-5585 (Print)
ISSN:1862-278X (Online)
First Page:4
Document Type:Conference Proceeding
Institutes:Hochschule Offenburg / Bibliografie
Release Date:2015/05/18
Licence (German):License LogoEs gilt das UrhG
Note:
Proceedings BMT 2011, 45. DGBMT Jahrestagung, Freiburg, 27.-30. September 2011.
DOI:https://doi.org/10.1515/bmt.2011.850