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Multi-site left ventricular pacing as a potential treatment for patients with postero-lateral scar: Insights from cardiac magnetic resonance imaging and invasive haemodynamic assessment

Ginks, Matthew R.; Duckett, Simon G.; Kapetanakis, Stamatis; Bostock, Julian; Hamid, Shoaib; Shetty, Anoop; Ma, Yingliang; Rhode, Kawal S.; Carr-White, Gerald S.; Razavi, Reza S.; Rinaldi, C. Aldo

Authors

Matthew R. Ginks

Simon G. Duckett

Stamatis Kapetanakis

Julian Bostock

Shoaib Hamid

Anoop Shetty

Yingliang Ma

Kawal S. Rhode

Gerald S. Carr-White

Reza S. Razavi

C. Aldo Rinaldi



Abstract

Aims Multi-site left ventricular (LV) pacing may be superior to single-site stimulation in correcting dyssynchrony and avoiding areas of myocardial scar. We sought to characterize myocardial scar using cardiac magnetic resonance imaging (CMR). We aimed to quantify the acute haemodynamic response to single-site and multi-site LV stimulation and to relate this to the position of the LV leads in relation to myocardial scar. MethodsTwenty patients undergoing cardiac resynchronization therapy had implantation of two LV leads. One lead (LV1) was positioned in a postero-lateral vein, the second (LV2) in a separate coronary vein. LV dP/dtmax was recorded using a pressure wire during stimulation at LV1, LV2, and both sites simultaneously (LV1 + 2). Patients were deemed acute responders if ΔLV dP/dtmax was ≥10%. Cardiac magnetic resonance imaging was performed to assess dyssynchrony as well as location and burden of scar. Scar anatomy was registered with fluoroscopy to assess LV lead position in relation to scar. ResultsLV dP/dtmax increased from 726 ± 161 mmHg/s in intrinsic rhythm to 912 ± 234 mmHg/s with LV1, 837 ± 188 mmHg/s with LV2, and 932 ± 201 mmHg/s with LV1 and LV2. Nine of 19 (47%) were acute responders with LV1 vs. 6/19 (32%) with LV2. Twelve of 19 (63) were acute responders with simultaneous LV1 + 2. Two of three patients benefitting with multi-site pacing had the LV1 lead positioned in postero-lateral scar. ConclusionMulti-site LV pacing increased acute response by 16 vs. single-site pacing. This was particularly beneficial in patients with postero-lateral scar identified on CMR. © The Author 2011.

Journal Article Type Article
Publication Date Mar 1, 2012
Journal Europace
Print ISSN 1099-5129
Electronic ISSN 1532-2092
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 14
Issue 3
Pages 373-379
DOI https://doi.org/10.1093/europace/eur336
Keywords heart failure, cardiac resynchronization therapy, multi-site LV pacing, haemodynamics, cardiac magnetic resonance
Public URL https://uwe-repository.worktribe.com/output/949308
Publisher URL http://dx.doi.org/10.1093/europace/eur336
Additional Information Corporate Creators : King's College London, Philips Healthcare, St. Thomas Hospital London


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