Circulation. 2001;104:3026-3029
doi: 10.1161/hc5001.102229
doi: 10.1161/hc5001.102229
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(Circulation. 2001;104:3026.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Effect of Resynchronization Therapy Stimulation Site on the Systolic Function of Heart Failure Patients
From the German Heart Institute and Charité, Campus Virchow Klinikum, Berlin (C.B., E.F.), the Division of Cardiology, University Hospital, Magdeburg (A.A.), and the Department of Cardiology, Rhein-Westfálische Technische Hochschule University Hospital, Aachen (C.S.), Germany; and Guidant-Cardiac Rhythm Management (J.D., Y.Y., E.H., J.S.).
Correspondence to Christian Butter, MD, Department of Internal Medicine/Cardiology, Charité, Campus Virchow Clinic, Humbolt University and German Heart Center, D-13353 Berlin, Germany. E-mail butter{at}dhzb.de
Background— Cardiac resynchronization therapy (CRT) improves systolic function in heart failure patients with ventricular conduction delay by stimulating the left ventricle (LV) or both ventricles (biventricular, BV). Optimal LV site selection is of major clinical interest for CRT device implantation; however, the dependence of hemodynamics on LV stimulation site has not been established. Thus, the objective of this study was to compare the hemodynamic response to CRT for 2 LV coronary vein sites: the free wall and anterior wall.
Methods and Results— A total of 30 patients (mean NYHA class, 2.7; mean QRS interval, 152 ms; mean PR interval, 194 ms) enrolled in the PATH-CHF-II trial were studied. CRT was administered with LV and BV stimulation in VDD mode at 4 AV delays. LV stimulation was at the lateral free wall or anterior wall, whereas right ventricular stimulation was fixed near the apex. LV+dP/dtmax and aortic pulse pressure changes from baseline during CRT were compared for LV sites. Free wall sites with LV and BV stimulation yielded significantly larger LV+dP/dtmax (14% versus 6%, P<0.001 for LV; 12% versus 5%, P<0.001 for BV) and pulse pressure (8% versus 4%, P<0.001 for LV; 9% versus 5%, P<0.001 for BV) compared with anterior sites. In one third of patients, CRT at free wall sites increased LV+dP/dtmax, whereas it decreased at anterior sites over most AV delays.
Conclusion— CRT with LV free wall stimulation produced significantly better LV systolic performance compared with anterior stimulation. Further studies are warranted to prove the clinical superiority of the LV free wall as a site for long-term CRT.
Key Words: heart failure • bundle-branch block • pacing • contractility • electrical stimulation
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