Vectorcardiography for Optimization of Stimulation Intervals in Cardiac Resynchronization Therapy

Current optimization of atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) is time consuming and subject to noise. We aimed to prove the principle that the best hemodynamic effect of CRT is achieved by cancelation of opposing electrical forces, detec...

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Bibliographic Details
Published in:Journal of cardiovascular translational research 2015-03, Vol.8 (2), p.128-137
Main Authors: van Deursen, Caroline J. M., Wecke, Liliane, van Everdingen, Wouter M., Ståhlberg, Marcus, Janssen, Michel H. G., Braunschweig, Frieder, Bergfeldt, Lennart, Crijns, Harry J. G. M., Vernooy, Kevin, Prinzen, Frits W.
Format: Article
Language:English
Subjects:
Action Potentials
Aged
Biomedical Engineering and Bioengineering
Biomedicine
Bundle-Branch Block - diagnosis
Bundle-Branch Block - physiopathology
Bundle-Branch Block - therapy
Cardiac and Cardiovascular Systems
Cardiac Resynchronization Therapy - methods
Cardiology
Female
Heart Conduction System - physiopathology
Hemodynamics
Human Genetics
Humans
Kardiologi
Male
Medicin och hälsovetenskap
Medicine
Medicine & Public Health
Middle Aged
Netherlands
Predictive Value of Tests
Reproducibility of Results
Sweden
Time Factors
Treatment Outcome
Vectorcardiography
Ventricular Function, Left
Ventricular Function, Right
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Summary:Current optimization of atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) is time consuming and subject to noise. We aimed to prove the principle that the best hemodynamic effect of CRT is achieved by cancelation of opposing electrical forces, detectable from the QRS morphology in the 3D vectorcardiogram (VCG). Different degrees of left (LV) and right ventricular (RV) pre-excitation were induced, using variation in AV intervals during LV pacing in 20 patients with left bundle branch block (LBBB) and variation in VV intervals during biventricular pacing in 18 patients with complete AV block or atrial fibrillation. The smallest QRS vector area identified stimulation intervals with minimal systolic stretch (median difference [IQR] 20 ms [−20, 20 ms] and maximal hemodynamic response (10 ms [−20, 40 ms]). Reliability of VCG measurements was superior to hemodynamic measurements. This study proves the principle that VCG analysis may allow easy and reliable optimization of stimulation intervals in CRT patients.
ISSN:1937-5387
1937-5395
1937-5395
DOI:10.1007/s12265-015-9615-7