The influence of right ventricular stimulation on acute response to cardiac resynchronisation therapy

• Published in: Netherlands heart journal 2016-01, Vol.24 (1), p.66-72
• Main Authors: Wu, L., de Roest, G.J., Hendriks, M.L., van Rossum, A.C., de Cock, C.C., Allaart, C.P.
• Format: Article
• Language: English
• Subjects: Cardiology; Ejection fraction; Heart failure; Hemodynamics; Medical Education; Medicine; Medicine & Public Health; Normal distribution; Original; Original Article; Regression analysis; Stroke
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-015-0770-x

Background The contribution of right ventricular (RV) stimulation to cardiac resynchronisation therapy (CRT) remains controversial. RV stimulation might be associated with adverse haemodynamic effects, dependent on intrinsic right bundle branch conduction, presence of scar, RV function and other factors which may partly explain non-response to CRT. This study investigates to what degree RV stimulation modulates response to biventricular (BiV) stimulation in CRT candidates and which baseline factors, assessed by cardiac magnetic resonance imaging, determine this modulation. Methods and results Forty-one patients (24 (59 %) males, 67 ± 10 years, QRS 153 ± 22 ms, 21 (51 %) ischaemic cardiomyopathy, left ventricular (LV) ejection fraction 25 ± 7 %), who successfully underwent temporary stimulation with pacing leads in the RV apex (RV apex ) and left ventricular posterolateral (PL) wall were included. Stroke work, assessed by a conductance catheter, was used to assess acute haemodynamic response during baseline conditions and RV apex , PL (LV) and PL+RV apex (BiV) stimulation. Compared with baseline, stroke work improved similarly during LV and BiV stimulation (∆+ 51 ± 42 % and ∆+ 48 ± 47 %, both p