Variation in optimal hemodynamic atrio-ventricular delay of biventricular pacing with different endocardial left ventricular lead locations using precision hemodynamics

Butcher, C.J.T. et al. (2023) Variation in optimal hemodynamic atrio-ventricular delay of biventricular pacing with different endocardial left ventricular lead locations using precision hemodynamics. Journal of Cardiovascular Electrophysiology, 34(6), pp. 1431-1440. (doi: 10.1111/jce.15862) (PMID:36786511)

Abstract

Background: It is not known whether the optimal Atrioventricular delay (AV opt) varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration. Methods: We assessed the haemodynamic AV opt in patients with chronic heart failure undergoing endocardial LV lead implantation. AV opt was assessed during atrio-biventricular pacing (BVP) with a “roving LV lead”. Up to four locations were studied: mid lateral wall, mid septum (or a close alternative), site of greatest haemodynamic improvement and LV lead implant site. The AV opt was compared to a fixed AV delay of 180ms. Results: Seventeen patients were included (12 male, aged 66.5 +/- 12.8 years, ejection fraction 26 +/- 7%, 16 left bundle branch block or high percentage of right ventricular pacing (RVP), QRS duration 167 +/-27 ms). In most locations (62/63), AV opt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, IQR 4-9mmHg). Compared to a fixed AV delay the haemodynamic improvement at AV opt was higher (1mmHg, IQR 0.2-2.6mmHg, p<0.001). Within most patients (16/17), we observed a difference in AV opt between pacing sites (median paced AV opt 209 ms, IQR 117-250). Within this range, the haemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6mmHg). Conclusion: Within a patient, different endocardial LV lead locations have slightly different haemodynamic AV opt which are superior to a fixed AV delay. The haemodynamic consequence of applying an optimum from a different lead location is small.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Butcher, C.J.T., Cantor, E., Sohaib, S.M.A., Shun-Shin, M., Haynes, R., Khan, H., Kyriacou, A., Shi, R., Chen, Z., Haldar, S., Cleland, J., Hussain, W., Markides, V., Jones, D., Lane, R.E., Mason, M.J., Whinnett, Z., Francis, D., and Wong, T.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Cardiovascular Electrophysiology
• Publisher: Wiley
• ISSN: 1045-3873
• ISSN (Online): 1540-8167
• Published Online: 14 February 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Journal of Cardiovascular Electrophysiology 34(6):1431-1440
• Publisher Policy: Reproduced under a Creative Commons licence

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