Design of an Acute dP/dt Hemodynamic Measurement Protocol to Isolate Cardiac Effect of Pacing

详细信息    查看全文

• 作者：Bernard Thibault ; MD¹ ; ^{ablation2000@bellnet.ca" class="auth_mail} ; Marc Dubuc ; MD¹ ; Edward Karst ; MS² ; Jason Andrade ; MD¹ ; Katia Dyrda ; MD¹ ; Peter G. Guerra ; MD¹ ; Laurent Macle ; MD¹ ; Lena Rivard ; MD¹ ; Denis Roy ; MD¹ ; Mario Talajic ; MD¹ ; Kyungmoo Ryu ; PhD² ; Taraneh G. Farazi ; PhD² ; Niraj Varma ; MD ; PhD³ ; Paul Khairy ; MD ; PhD¹
• 关键词：Heart failure ; resynchronization therapy
• 刊名：Journal of Cardiac Failure
• 出版年：May 2014
• 年：2014
• 卷：20
• 期：5
• 页码：365-372
• 全文大小：893 K

文摘

Invasively measured maximum increase in left ventricular pressure (LV dP/dt_max) has been used to assess biventricular (BiV) pacing. We quantified extracardiac factors contributing to its variability, and developed a protocol to minimize these effects in an acute pacing experiment.

Methods and Results

Continuous pressure was recorded by a guidewire sensor placed in the LV. Four to six test pacing interventions were performed, each repeated 3 times and followed by a baseline pacing configuration. Maximum increase in LV dP/dt_max from any measurement of BiV pacing was median 20.3% in 25 patients, compared with BiV pacing off. When directly comparing sequential measurements with BiV pacing on and off, median increase was 7.4%. Noncardiac sources of modulation included respiratory variation (6.4%), drift from first to last baseline measurement (5.0%), and discrepancy among repeated recordings of the same pacing intervention (3.3%). Comparing test interventions to interleaved baseline measurements reduced discrepancy among recordings to 2.1%; P < .001.

Conclusions

With repeated measurements of baseline state, and by comparing test interventions only to baseline measurements performed before and after, it is possible to minimize extracardiac factors and focus on the effects of test pacing interventions.