Benefits of endocardial and multisite pacing are dependent on the type of left ventricular electric activation pattern and presence of ischemic heart disease: insights from electroanatomic mapping

Matthew R. Ginks*, Anoop K. Shetty, Pier D. Lambiase, Simon G. Duckett, Julian Bostock, Janet L. Peacock, Kawal S. Rhode, Cliff Bucknall, Jaswinder Gill, Peter Taggart, Christophe Leclercq, Gerald S. Carr-White, Reza Razavi, C. Aldo Rinaldi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

68 Citations (Scopus)

Abstract

Background-There is considerable heterogeneity in the myocardial substrate of patients undergoing cardiac resynchronization therapy (CRT), in particular in the etiology of heart failure and in the location of conduction block within the heart. This may account for variability in response to CRT. New approaches, including endocardial and multisite left ventricular (LV) stimulation, may improve CRT response. We sought to evaluate these approaches using noncontact mapping to understand the underlying mechanisms.

Methods and Results-Ten patients (8 men and 2 women; mean [SD] age 63 [12] years; LV ejection fraction 246%; QRS duration 161 [24] ms) fulfilling conventional CRT criteria underwent an electrophysiological study, with assessment of acute hemodynamic response to conventional CRT as well as LV endocardial and multisite pacing. LV activation pattern was assessed using noncontact mapping. LV endocardial pacing gave a superior acute hemodynamic response compared with conventional CRT (26% versus 37% increase in LV dP/dt(max), respectively; P

Conclusions-Endocardial or multisite pacing may be required in certain subsets of patients undergoing CRT. Patients with ischemic cardiomyopathy and those with narrower QRS, in particular, may stand to benefit. (Circ Arrhythm Electrophysiol. 2012;5:889-897.)

Original languageEnglish
Pages (from-to)889-897
Number of pages9
JournalCirculation-Arrhythmia And Electrophysiology
Volume5
Issue number5
DOIs
Publication statusPublished - 25 Jul 2012

Keywords

  • Magnetic Resonance Imaging
  • Heart Failure
  • Humans
  • Myocardial Ischemia
  • Hemodynamics
  • Bundle-Branch Block
  • Gadolinium DTPA
  • Electrophysiologic Techniques, Cardiac
  • Cardiac Resynchronization Therapy
  • Treatment Outcome
  • Middle Aged
  • Female
  • Heart Ventricles
  • Male

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