Heart failure & cardiomyopathies
Comparison of acute hemodynamic effect of prioritizing ventricular resynchronization vs left ventricular filling during optimization of cardiac resynchronization therapy
Authors' conclusion
Targeting the maximal ventricular resynchronization results in suboptimal acute hemodynamic performance with both BVP and LBBP as CRT.
Study context
- Population
- Patients with standard cardiac resynchronization therapy (CRT) indications undergoing biventricular pacing (BVP) and left bundle branch pacing (LBBP)
- Participants
- 30 patients
- Comparison
- Atrioventricular delay (AVD) with shortest QRS duration (QRSd) vs AVD with most efficient left ventricular (LV) filling
- Outcome
- Acute haemodynamic response of systolic blood pressure (SBP)
Methodological details2 centres, within-patient comparison, acute haemodynamic study
- 2 centres
- Within-patient comparison
- Acute haemodynamic study
Main finding
As reported in the abstract
Acute SBP improvement
- BVP; ± 4 mm Hg
- difference −3 mm Hg; P < 0.01
- LBBP; ± 2 mm Hg
- difference −2 mm Hg; P < 0.01
Further findings
QRSd, maximal resynchronization AVD vs AVD optimizing filling
- Shorter QRSd, BVP (difference)
- 15 ± 12 ms
- Shorter QRSd, LBBP (difference)
- 18 ± 13 ms
- Both P <.01
dP/dtmax (validation substudy), AVD assessed with QRSd or QRS area (QRSa) vs AVD optimizing filling
- Smaller dP/dtmax improvement, QRSd-guided, BVP (difference)
- −9% ± 7%
- Smaller dP/dtmax improvement, QRSa-guided, BVP (difference)
- −6% ± 4%
- Smaller dP/dtmax improvement, QRSd-guided, LBBP (difference)
- −5% ± 6%
- Smaller dP/dtmax improvement, QRSa-guided, LBBP (difference)
- −3% ± 3%
- All P <.01
Original publication
Comparison of acute hemodynamic effect of prioritizing ventricular resynchronization vs left ventricular filling during optimization of cardiac resynchronization therapy. Heart Rhythm. Published 17 September 2024. doi:10.
Summarised from the published abstract; every number is checked against it