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Europace 2005 7(3):288; doi:10.1016/j.eupc.2005.02.007
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

CP06: HEMODYNAMIC EFFECT OF RV APEX VS RV SEPTUM PACING IN A MONOVENTRICULAR AND BIVENTRICULAR CONFIGURATION IN PATIENTS WITH HEART FAILURE

Berry M. van Gelder, Frank A. Bracke, Lex Lakerveld, Albert Meijer and Nico H Pijls

Catharina Hospital Eindhoven, The Netherlands

We evaluated the hemodynamic effect of the right ventricular apex (RVA) and right ventricular septum (RVS) position in a monoventricular and biventricular configuration. Study included 82 patients (23 female, age 69.2±8.4 years) with heart failure NYHA class III-IV and a QRS width >130 ms with left bundle branch configuration. Biventricular pacing systems with programmable V-V intervals were implanted with coronary sinus leads positioned in one of the postero-lateral coronary veins. Right ventricular leads were randomly placed in the RVA (group A, 51 patients) and the RVS (group B, 31 patients). Hemodynamic effect of the RV pacing site was evaluated by invasive measurement of left ventricular (LV) dP/dtmax derived from left ventricular pressure measured with a 0.014' pressure tipped guide wire introduced through a 4F multipurpose catheter positioned in the left ventricular cavity. Baseline dP/dtmax increased by monoventricular RV pacing by 4.5% in group A and 3.4% in group B (p =0.63). Left ventricular pacing increased LV dP/dt with 25.8 % in group A and 20.3% in group B (p=0.23). Biventricular pacing in group A increased LV dp/dt with 25.3% and in group B with 16.6% (p=0.04). After optimization of the V-V interval, biventricular pacing increased LV dP/dt with 31.8% and 23.0 % respectively in group A and B (p=0.055).

CONCLUSION: In patients with heart failure there is no significant difference on LV dP/dtmax comparing RVA and RVS pacing only. Combined with BiV pacing, there is a trend towards superiority of RV apical pacing, although only significantly without V-V optimization. Similar improvement with only LV pacing eliminates the influence of the LV pacing site on the latter results.


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