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

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 fac...

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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
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container_title Netherlands heart journal
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Hendriks, M.L.
van Rossum, A.C.
de Cock, C.C.
Allaart, C.P.
description 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  
doi_str_mv 10.1007/s12471-015-0770-x
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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  &lt; 0.001), but individual response showed substantial differences between LV and BiV stimulation. Multivariate analysis revealed that RV ejection fraction (β = 1.01, p  = 0.02) was an independent predictor for stroke work response during LV stimulation, but not for BiV stimulation. Other parameters, including atrioventricular delay and scar presence and localisation, did not predict stroke work response in CRT. Conclusion The haemodynamic effect of addition of RV apex stimulation to LV stimulation differs widely among patients receiving CRT. Poor RV function is associated with poor response to LV but not BiV stimulation.</description><identifier>ISSN: 1568-5888</identifier><identifier>EISSN: 1876-6250</identifier><identifier>DOI: 10.1007/s12471-015-0770-x</identifier><identifier>PMID: 26649436</identifier><language>eng</language><publisher>Houten: Bohn Stafleu van Loghum</publisher><subject>Cardiology ; Ejection fraction ; Heart failure ; Hemodynamics ; Medical Education ; Medicine ; Medicine &amp; Public Health ; Normal distribution ; Original ; Original Article ; Regression analysis ; Stroke</subject><ispartof>Netherlands heart journal, 2016-01, Vol.24 (1), p.66-72</ispartof><rights>The Author(s) 2015</rights><rights>The Author(s) 2015. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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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  &lt; 0.001), but individual response showed substantial differences between LV and BiV stimulation. Multivariate analysis revealed that RV ejection fraction (β = 1.01, p  = 0.02) was an independent predictor for stroke work response during LV stimulation, but not for BiV stimulation. Other parameters, including atrioventricular delay and scar presence and localisation, did not predict stroke work response in CRT. Conclusion The haemodynamic effect of addition of RV apex stimulation to LV stimulation differs widely among patients receiving CRT. Poor RV function is associated with poor response to LV but not BiV stimulation.</description><subject>Cardiology</subject><subject>Ejection fraction</subject><subject>Heart failure</subject><subject>Hemodynamics</subject><subject>Medical Education</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Normal distribution</subject><subject>Original</subject><subject>Original Article</subject><subject>Regression analysis</subject><subject>Stroke</subject><issn>1568-5888</issn><issn>1876-6250</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNp1kUtr3DAUhUVpaJJJf0A3RdBNN270lrwplNCmhUA3yVrImuuxgkeaSnbI_PvKOE0fUBDoovvdo3s4CL2h5AMlRF8WyoSmDaGyIVqT5vEFOqNGq0YxSV7WWirTSGPMKTov5Z4QqRnVr9ApU0q0gqszBLcD4BD7cYboAace57AbJvwAccrBz6PLuExhX4sppIjrcX6eAGcohxQL4Clh7_I2OL-8HaMfcoqhrPg0QHaH4wU66d1Y4PXTvUF3Xz7fXn1tbr5ff7v6dNN4ocnUdN6BJs57Y1gPRErBhRS6q2ZbLsBw1bXbntBWOSZUR5hsNd1STXrjFO8F36CPq-5h7vaw9YsJN9pDDnuXjza5YP_uxDDYXXqwQrXMcF4F3j8J5PRjhjLZfSgextFFSHOxVEsmjTJ1nw169w96n-Ycqz3LtBGGKcoXiq6Uz6mUDP3zMpTYJUS7hmhriHYJ0T7Wmbd_unie-JVaBdgKlNqKO8i_v_6_6k-DM6oo</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Wu, L.</creator><creator>de Roest, G.J.</creator><creator>Hendriks, M.L.</creator><creator>van Rossum, A.C.</creator><creator>de Cock, C.C.</creator><creator>Allaart, C.P.</creator><general>Bohn Stafleu van Loghum</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160101</creationdate><title>The influence of right ventricular stimulation on acute response to cardiac resynchronisation therapy</title><author>Wu, L. ; 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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  &lt; 0.001), but individual response showed substantial differences between LV and BiV stimulation. Multivariate analysis revealed that RV ejection fraction (β = 1.01, p  = 0.02) was an independent predictor for stroke work response during LV stimulation, but not for BiV stimulation. Other parameters, including atrioventricular delay and scar presence and localisation, did not predict stroke work response in CRT. Conclusion The haemodynamic effect of addition of RV apex stimulation to LV stimulation differs widely among patients receiving CRT. Poor RV function is associated with poor response to LV but not BiV stimulation.</abstract><cop>Houten</cop><pub>Bohn Stafleu van Loghum</pub><pmid>26649436</pmid><doi>10.1007/s12471-015-0770-x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Cardiology
Ejection fraction
Heart failure
Hemodynamics
Medical Education
Medicine
Medicine & Public Health
Normal distribution
Original
Original Article
Regression analysis
Stroke
title The influence of right ventricular stimulation on acute response to cardiac resynchronisation therapy
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