Clinical and Procedural Characteristics of Acute Hemodynamic Responders Undergoing Triple-Site Ventricular Pacing for Advanced Heart Failure

详细信息    查看全文

• 作者：Hiro  ; Yamasaki MD ; Yoshihiro  ; Seo MD  ; ;   ; ^{yo-seo@md.tsukuba.ac.jp} ; Hiroshi  ; Tada MD ; Yukio  ; Sekiguchi MD ; Takanori  ; Arimoto MD ; Miyako  ; Igarashi MD ; Kenji  ; Kuroki MD ; Takeshi  ; Machino MD ; Kentaro  ; Yoshida MD ; Nobuyuki  ; Murakoshi MD ; Tomoko  ; Ishizu MD ; Kazutaka  ; Aonuma MD
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：1 November 2011
• 年：2011
• 卷：108
• 期：7
• 页码：1297-1304
• 全文大小：1524 K

文摘

The advantages of triple-site ventricular pacing (Tri-V) compared to conventional biventricular site pacing (Bi-V) have been reported. We sought to identify the predictors of acute hemodynamic Tri-V responders. Acute hemodynamic studies were performed in 32 patients with advanced heart failure during Tri-V implantation. After the right ventricular (RV) and left ventricular (LV) leads were implanted for a conventional Bi-V system, an additional pacing lead was implanted in the RV outflow tract for Tri-V. The LV peak +dP/dt and tau were measured during AAI, Bi-V, and Tri-V pacing. A Tri-V responder was defined as a patient whose percentage of increase in the peak +dP/dt during Tri-V was >10 % compared to of that during Bi-V. The baseline clinical variables and RV outflow tract lead location were analyzed to identify the characteristics of the Tri-V responders. Of the 32 patients, 10 (31 % ) were classified as Tri-V responders. The LV end-diastolic volume was greater (246 ¡À 48 vs 173 ¡À 53 ml, p <0.01), and the RV outflow tract lead was implanted at a greater outflow tract portion (p <0.05) in the Tri-V responders. Multivariate analysis revealed that only the baseline LV end-diastolic volume (per 50-ml greater) predicted the Tri-V response (odds ratio 2.87, 95 % confidence interval 1.03 to 8.00, p <0.05). The area under the receiver operating characteristic curve for the LV end-diastolic volume was 0.84 (p <0.01) and an LV end-diastolic volume of >212 ml had a sensitivity of 80 % and specificity of 77 % to distinguish Tri-V responders. In conclusion, Tri-V provides greater hemodynamic effect for patients with a larger LV end-diastolic volume owing to its resynchronization effects on the LV anterior wall.