Scar tissue–guided left ventricular lead placement for cardiac resynchronization therapy in patients with ischemic cardiomyopathy: An acute pressure-volume loop study - 22/03/14
, LiNa Wu, MD a, Carel C. de Cock, MD, PhD a, Matthijs L. Hendriks, MPA a, Peter Paul H.M. Delnoy, MD, PhD b, Albert C. van Rossum, MD, PhD a, c, Cornelis P. Allaart, MD, PhD aRiassunto |
Background |
Response to cardiac resynchronization therapy (CRT) is hampered by the extent and location of left ventricular (LV) scar tissue. It is commonly advised to avoid scar tissue while placing the LV lead. However, whether individual patients benefit from this strategy remains unclear.
Methods |
Thirty-two CRT candidates with ischemic cardiomyopathy were enrolled from 2 successive clinical trials (TBS and E-pot study). Magnetic resonance imaging with late contrast enhancement was performed to assess location, degree and transmurality of LV scar tissue. Patients underwent invasive pressure-volume loop measurements to assess acute LV pump function changes during pacing at posterolateral (PL) and anterolateral LV sites.
Results |
In the study population (26 [81%] men, ejection fraction [EF] 22% ± 8%, QRS 149 ± 20 milliseconds), baseline mean stroke work (SW) and dP/dtmax were 4.4 ± 2.2 L∙mmHg and 849 ± 212 mmHg/s, respectively. The extent of scar tissue was inversely related to the acute increase in SW during pacing (R = −0.53, P = .002). Stimulating PL scar tissue resulted in deterioration of pump function (∆SW −17% ± 17%, P = .018), whereas pacing PL viable tissue led to an increase in pump function (∆SW +62% ± 51%, P < .001). Switching from pacing at the location of scar tissue, irrespective of the scar location, to viable tissue showed a significant increase in SW (−8% ± 20% vs +20 ± 40, P = .004).
Conclusions |
The extent of LV scar tissue is inversely related to acute pump function improvement during CRT. Pacing at the location of (transmural) scar tissue at any site of the LV will generally deteriorate LV pump function. Placing the LV lead over viable myocardium significantly improves pump function as compared with pacing at the location of scar tissue in patients with ischemic cardiomyopathy.
Il testo completo di questo articolo è disponibile in PDF.Mappa
Vol 167 - N° 4
P. 537-545 - aprile 2014 Ritorno al numero
Articolo precedente
- Clevidipine in acute heart failure: Results of the A Study of Blood Pressure Control in Acute Heart Failure—A Pilot Study (PRONTO)
- W. Frank Peacock, Abhinav Chandra, Douglas Char, Sean Collins, Guillaume Der Sahakian, Li Ding, Lala Dunbar, Gregory Fermann, Gregg C. Fonarow, Norman Garrison, Ming-yi Hu, Patrick Jourdain, Said Laribi, Phillip Levy, Martin Möckel, Christian Mueller, Patrick Ray, Adam Singer, Hector Ventura, Mason Weiss, Alex Mebazaa
- Acute echocardiographic optimization of multiple stimulation configurations of cardiac resynchronization therapy through quadripolar left ventricular pacing: A tailored approach
- Leonardo Calò, Annamaria Martino, Ermenegildo de Ruvo, Monia Minati, Simona Fratini, Marco Rebecchi, Chiara Lanzillo, Alessandro Fagagnini, Alessio Borrelli, Lucia De Luca, Luigi Sciarra
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?