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Europace Advance Access originally published online on October 6, 2009
Europace 2009 11(11):1496-1500; doi:10.1093/europace/eup288
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Pacing and CRT

Right ventricular contractility as a measure of optimal interventricular pacing setting in cardiac resynchronization therapy

Elena Sciaraffia*, Helena Malmborg, Stefan Lönnerholm, Per Blomström and Carina Blomström Lundqvist

Department of Cardiology, Uppsala University Hospital, S-751 85 Uppsala, Sweden

Aims: The aim of the present study was to assess whether right ventricular (RV) contractility can be used for optimization of the interventricular (VV) interval and to study the acute hemodynamic effect of different VV intervals on right and left ventricular (LV) contractility in patients referred for cardiac resynchronization therapy (CRT).

Methods and results: Intracardiac LV and RV dP/dt were measured with a 0.014-in. sensor-tipped pressure guidewire during pacing at nine different VV intervals ranging from +80 ms (LV pre-excitation) to –80 ms (RV pre-excitation) in 26 patients who received a biventricular pacemaker. No correlation was found between the optimal VV intervals identified by maximum LV dP/dt and RV dP/dt, which were identical in only seven cases (27%). Only when testing slightly broader intervals (±20 ms) was there a statistically significant correlation (P= 0.037) between the optimized VV intervals. In the majority of patients (58%) either LV or RV pre-excitation was superior to simultaneous pacing according to LV dP/dtmax measurements.

Conclusion: RV dP/dtmax failed to identify the optimal VV interval when compared with LV dP/dtmax and can therefore not be recommended for VV optimization in CRT patients.

Key Words: Cardiac resynchronization therapy, Optimization, Contractility

* Corresponding author. Tel: +46 18 611 02 36, Fax: +46 18 51 02 43, Email: elena.sciaraffia{at}akademiska.se

Manuscript submitted 7 July 2009. Accepted after revision 7 September 2009.


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