1. A simultaneous X-Ray/MRI and noncontact mapping study of the acute hemodynamic effect of left ventricular endocardial and epicardial cardiac resynchronization therapy in humans
- Author
-
Julian Bostock, Kawal Rhode, Simon G. Duckett, Pier D. Lambiase, Marcus Simon, Phani Chinchapatnam, C. Aldo Rinaldi, Cliff Bucknall, Matthew Ginks, Reza Razavi, Mark J. W. McPhail, and Gerald Carr-White
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Heart Ventricles ,Cardiac resynchronization therapy ,Ventricular Function, Left ,Cardiac Resynchronization Therapy ,Predictive Value of Tests ,Internal medicine ,London ,medicine ,Ventricular Pressure ,Pericardium ,Humans ,Endocardium ,Aged ,Heart Failure ,Analysis of Variance ,Ischemic cardiomyopathy ,Bundle branch block ,medicine.diagnostic_test ,business.industry ,X-Rays ,Hemodynamics ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Treatment Outcome ,Heart failure ,Ventricular pressure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac - Abstract
Background— Cardiac resynchronization therapy (CRT) using endocardial left ventricular (LV) pacing may be superior to conventional CRT. We studied the acute hemodynamic response to conventional CRT and LV pacing from different endocardial sites using a combined cardiac MRI and LV noncontact mapping (NCM) protocol to gain insights into the underlying mechanisms. Methods and Results— Fifteen patients (age, 63±10 years; 12 men) awaiting CRT were studied in a combined x-ray and MRI laboratory. Delayed-enhancement cardiac magnetic resonance was performed to define areas of myocardial fibrosis. Patients underwent an electrophysiological study incorporating endocardial and epicardial LV pacing. Acute hemodynamic response was measured using a pressure wire within the LV cavity to derive LV dP/dt max. NCM was used to define areas of slow conduction. There was a significant improvement in all LV pacing modes versus baseline ( P P P Conclusions— Endocardial LV pacing appears superior to conventional CRT, although the optimal site varies between subjects and is influenced by pacing within areas of slow conduction. Delayed-enhancement cardiac magnetic resonance was a poor predictor of zones of slow conduction in nonischemic patients.
- Published
- 2011