Electrical latency predicts the optimal left ventricular endocardial pacing site: Results from a multicentre international registry

Benjamin J. Sieniewicz, Jonathan M. Behar, Manav Sohal, Justin Gould, Simon Claridge, Bradley Porter, Steve Niederer, James H.P. Gamble, Tim R. Betts, Pierre Jais, Nicolas Derval, David D Spragg, Paul Steendijk, Berry M. van Gelder, Frank A. Bracke, Christopher A. Rinaldi

Research output: Contribution to journalArticle

Abstract

Aims The optimal site for biventricular endocardial (BIV ENDO ) pacing remains undefined. Acute haemodynamic response (AHR) is reproducible marker of left ventricular (LV) contractility, best expressed as the change in the maximum rate of LV pressure (LV-dp/dt max ), from a baseline state. We examined the relationship between factors known to impact LV contractility, whilst delivering BIV ENDO pacing at a variety of LV endocardial (LV ENDO ) locations. Methods and results We compiled a registry of acute LV ENDO pacing studies from five international centres: Johns Hopkins-USA, Bordeaux-France, Eindhoven-The Netherlands, Oxford-United Kingdom, and Guys and St Thomas’ NHS Foundation Trust, London-UK. In all, 104 patients incorporating 687 endocardial and 93 epicardial pacing locations were studied. Mean age was 66 ± 11 years, mean left ventricular ejection fraction 24.6 ± 7.7% and mean QRS duration of 163 ± 30 ms. In all, 50% were ischaemic [ischaemic cardiomyopathy (ICM)]. Scarred segments were associated with worse haemodynamics (dp/dt max ; 890 mmHg/s vs. 982 mmHg/s, P < 0.01). Delivering BiV ENDO pacing in areas of electrical latency was associated with greater improvements in AHR (P < 0.01). Stimulating late activating tissue (LVLED >50%) achieved greater increases in AHR than non-late activating tissue (LVLED < 50%) (8.6 ± 9.6% vs. 16.1 ± 16.2%, P = 0.002). However, the LV ENDO pacing location with the latest Q-LV, was associated with the optimal AHR in just 62% of cases. Conclusions Identifying viable LV ENDO tissue which displays late electrical activation is crucial to identifying the optimal BiV ENDO pacing site. Stimulating late activating tissue (LVLED >50%) yields greater improvements in AHR however, the optimal location is frequently not the site of latest activation.

Original languageEnglish (US)
Pages (from-to)1989-1996
Number of pages8
JournalEuropace
Volume20
Issue number12
DOIs
StatePublished - Jan 1 2018

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Keywords

  • Biventricular pacing/cardiac resynchronization therapy
  • Leadless pacing
  • Left ventricular endocardial pacing
  • Personalized medicine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sieniewicz, B. J., Behar, J. M., Sohal, M., Gould, J., Claridge, S., Porter, B., Niederer, S., Gamble, J. H. P., Betts, T. R., Jais, P., Derval, N., Spragg, D. D., Steendijk, P., van Gelder, B. M., Bracke, F. A., & Rinaldi, C. A. (2018). Electrical latency predicts the optimal left ventricular endocardial pacing site: Results from a multicentre international registry. Europace, 20(12), 1989-1996. https://doi.org/10.1093/europace/euy052