Author + information
- Received July 24, 2019
- Revision received October 31, 2019
- Accepted November 8, 2019
- Published online January 27, 2020.
- Floor C.W.M. Salden, MDa,∗ (, )@FloorSalden,
- Justin G.L.M. Luermans, MD, PhDb,c,
- Sjoerd W. Westra, MDb,c,
- Bob Weijs, MD, PhDb,
- Elien B. Engels, MSc, PhDa,d,
- Luuk I.B. Heckman, MDa,
- Léon J.M. Lamerichs, RNb,
- Michel H.G. Janssen, BScb,
- Kristof J.H. Clerx, RNb,
- Richard Cornelussen, PhDa,e,
- Subham Ghosh, PhDf,
- Frits W. Prinzen, PhDa and
- Kevin Vernooy, MD, PhDb,c
- aDepartment of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- bDepartment of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- cDepartment of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
- dDepartment of Medicine, University of Western Ontario, London, Ontario, Canada
- eMedtronic PLC, Bakken Research Center, Maastricht, the Netherlands
- fMedtronic PLC, Cardiac Rhythm and Heart Failure (CRHF), Mounds View, Minnesota
- ↵∗Address for correspondence:
Dr. Floor C.W.M. Salden, Maastricht University, Department of Physiology, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
Background Cardiac resynchronization therapy (CRT) is usually performed by biventricular (BiV) pacing. Previously, feasibility of transvenous implantation of a lead at the left ventricular (LV) endocardial side of the interventricular septum, referred to as LV septal (LVs) pacing, was demonstrated.
Objectives The authors sought to compare the acute electrophysiological and hemodynamic effects of LVs with BiV and His bundle (HB) pacing in CRT patients.
Methods Temporary LVs pacing (transaortic approach) alone or in combination with right ventricular (RV) (LVs+RV), BiV, and HB pacing was performed in 27 patients undergoing CRT implantation. Electrophysiological changes were assessed using electrocardiography (QRS duration), vectorcardiography (QRS area), and multielectrode body surface mapping (standard deviation of activation times [SDAT]). Hemodynamic changes were assessed as the first derivative of LV pressure (LVdP/dtmax).
Results As compared with baseline, LVs pacing resulted in a larger reduction in QRS area (to 73 ± 22 μVs) and SDAT (to 26 ± 7 ms) than BiV (to 93 ± 26 μVs and 31 ± 7 ms; both p < 0.05) and LVs+RV pacing (to 108 ± 37 μVs; p < 0.05; and 29 ± 8 ms; p = 0.05). The increase in LVdP/dtmax was similar during LVs and BiV pacing (17 ± 10% vs. 17 ± 9%, respectively) and larger than during LVs+RV pacing (11 ± 9%; p < 0.05). There were no significant differences between basal, mid-, or apical LVs levels in LVdP/dtmax and SDAT. In a subgroup of 16 patients, changes in QRS area, SDAT, and LVdP/dtmax were comparable between LVs and HB pacing.
Conclusions LVs pacing provides short-term hemodynamic improvement and electrical resynchronization that is at least as good as during BiV and possibly HB pacing. These results indicate that LVs pacing may serve as a valuable alternative for CRT.
- body surface mapping
- cardiac resynchronization therapy
- heart failure
- His bundle pacing
- ventricular septum
A part of this study was financially supported by Medtronic (Minneapolis, Minnesota). Dr. Luermans has a consultancy agreement with Medtronic; and has received an educational grant from Biotronik. Dr. Engels has received a post-doctoral research fellowship from the Cardiac Arrhythmia Network of Canada (CANet). Dr. Cornelussen is an employee of Medtronic. Dr. Ghosh is an employee of and stock holder in Medtronic. Dr. Prinzen has received research grants from Medtronic, Abbott, Microport CRM, Biosense Webster, MDS, and Biotronik; and has served as an advisor to Oracle Health. Dr. Vernooy has received research grants from Medtronic, Abbott, and Biotronik; and has a consultancy agreement with Medtronic and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 24, 2019.
- Revision received October 31, 2019.
- Accepted November 8, 2019.
- 2020 American College of Cardiology Foundation
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