Acute effects of biventricular pacing in heart failure patients with a normal ejection fraction and mechanical dyssynchrony

Yi Chih Wang, Chih Chieh Yu, Fu Chun Chiu, Vincent Splett, Ruth Klepfer, Kathryn Hilpisch, Chia Ti Tsai, Ling Ping Lai, Juey Jen Hwang, Jiunn Lee Lin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: We tested the acute effects of resynchronization in heart failure patients with a normal (>50%) left ventricular (LV) ejection fraction (HFNEF) and mechanical dyssynchrony. Methods: Twenty-four HFNEF patients (72 ± 6 years, 5 male) with mechanical dyssynchrony (standard deviation of electromechanical time delay among 12 LV segments >35 ms) were studied with temporary pacing catheters in the right atrium, LV, and right ventricle (RV), and high-fidelity catheters for pressure recording. Using selected atrioventricular (AV) intervals of 60, 90, 120, 150, and 180 ms to optimize transmitral flow during simultaneous biventricular pacing, the RV-LV (VV) interval was then evaluated at RV30, RV15, 0, LV15, LV30, and LV45 (RV or LV indicates which ventricle was paced first, the number indicates by how many ms). Results: During simultaneous pacing, longer AV intervals were associated with improved LV pressure-derivative minimums and increased aortic pressures (p < 0.05 vs. normal sinus rhythm). In the VV interval from RV30 to LV45, there was a graded increase in the aortic velocity time integral and a decrease in dyssynchrony during simultaneous or LV-first pacing (p < 0.05 vs. normal sinus rhythm). Conclusions: For HFNEF patients with mechanical dyssynchrony, acute simultaneous biventricular or LV-first pacing with longer AV intervals reduced mechanical dyssynchrony and improved diastolic and systolic hemodynamics.

Original languageEnglish
Pages (from-to)112-119
Number of pages8
JournalCardiology (Switzerland)
Volume130
Issue number2
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

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Cardiac Resynchronization Therapy
Heart Ventricles
Heart Failure
Catheters
Ventricular Pressure
Heart Atria
Stroke Volume
Arterial Pressure
Hemodynamics
Pressure

Keywords

  • Heart failure
  • Hemodynamics
  • Pacing
  • Systolic dyssynchrony

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Acute effects of biventricular pacing in heart failure patients with a normal ejection fraction and mechanical dyssynchrony. / Wang, Yi Chih; Yu, Chih Chieh; Chiu, Fu Chun; Splett, Vincent; Klepfer, Ruth; Hilpisch, Kathryn; Tsai, Chia Ti; Lai, Ling Ping; Hwang, Juey Jen; Lin, Jiunn Lee.

In: Cardiology (Switzerland), Vol. 130, No. 2, 01.01.2015, p. 112-119.

Research output: Contribution to journalArticle

Wang, YC, Yu, CC, Chiu, FC, Splett, V, Klepfer, R, Hilpisch, K, Tsai, CT, Lai, LP, Hwang, JJ & Lin, JL 2015, 'Acute effects of biventricular pacing in heart failure patients with a normal ejection fraction and mechanical dyssynchrony', Cardiology (Switzerland), vol. 130, no. 2, pp. 112-119. https://doi.org/10.1159/000368795
Wang, Yi Chih ; Yu, Chih Chieh ; Chiu, Fu Chun ; Splett, Vincent ; Klepfer, Ruth ; Hilpisch, Kathryn ; Tsai, Chia Ti ; Lai, Ling Ping ; Hwang, Juey Jen ; Lin, Jiunn Lee. / Acute effects of biventricular pacing in heart failure patients with a normal ejection fraction and mechanical dyssynchrony. In: Cardiology (Switzerland). 2015 ; Vol. 130, No. 2. pp. 112-119.
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AU - Splett, Vincent

AU - Klepfer, Ruth

AU - Hilpisch, Kathryn

AU - Tsai, Chia Ti

AU - Lai, Ling Ping

AU - Hwang, Juey Jen

AU - Lin, Jiunn Lee

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N2 - Objectives: We tested the acute effects of resynchronization in heart failure patients with a normal (>50%) left ventricular (LV) ejection fraction (HFNEF) and mechanical dyssynchrony. Methods: Twenty-four HFNEF patients (72 ± 6 years, 5 male) with mechanical dyssynchrony (standard deviation of electromechanical time delay among 12 LV segments >35 ms) were studied with temporary pacing catheters in the right atrium, LV, and right ventricle (RV), and high-fidelity catheters for pressure recording. Using selected atrioventricular (AV) intervals of 60, 90, 120, 150, and 180 ms to optimize transmitral flow during simultaneous biventricular pacing, the RV-LV (VV) interval was then evaluated at RV30, RV15, 0, LV15, LV30, and LV45 (RV or LV indicates which ventricle was paced first, the number indicates by how many ms). Results: During simultaneous pacing, longer AV intervals were associated with improved LV pressure-derivative minimums and increased aortic pressures (p < 0.05 vs. normal sinus rhythm). In the VV interval from RV30 to LV45, there was a graded increase in the aortic velocity time integral and a decrease in dyssynchrony during simultaneous or LV-first pacing (p < 0.05 vs. normal sinus rhythm). Conclusions: For HFNEF patients with mechanical dyssynchrony, acute simultaneous biventricular or LV-first pacing with longer AV intervals reduced mechanical dyssynchrony and improved diastolic and systolic hemodynamics.

AB - Objectives: We tested the acute effects of resynchronization in heart failure patients with a normal (>50%) left ventricular (LV) ejection fraction (HFNEF) and mechanical dyssynchrony. Methods: Twenty-four HFNEF patients (72 ± 6 years, 5 male) with mechanical dyssynchrony (standard deviation of electromechanical time delay among 12 LV segments >35 ms) were studied with temporary pacing catheters in the right atrium, LV, and right ventricle (RV), and high-fidelity catheters for pressure recording. Using selected atrioventricular (AV) intervals of 60, 90, 120, 150, and 180 ms to optimize transmitral flow during simultaneous biventricular pacing, the RV-LV (VV) interval was then evaluated at RV30, RV15, 0, LV15, LV30, and LV45 (RV or LV indicates which ventricle was paced first, the number indicates by how many ms). Results: During simultaneous pacing, longer AV intervals were associated with improved LV pressure-derivative minimums and increased aortic pressures (p < 0.05 vs. normal sinus rhythm). In the VV interval from RV30 to LV45, there was a graded increase in the aortic velocity time integral and a decrease in dyssynchrony during simultaneous or LV-first pacing (p < 0.05 vs. normal sinus rhythm). Conclusions: For HFNEF patients with mechanical dyssynchrony, acute simultaneous biventricular or LV-first pacing with longer AV intervals reduced mechanical dyssynchrony and improved diastolic and systolic hemodynamics.

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