Right ventricular lead adjustment in cardiac resynchronization therapy and acute hemodynamic response: A pilot study

Prabhat Kumar, Gaurav A. Upadhyay, Christine Cavaliere-Ogus, E. Kevin Heist, Robert K. Altman, Neal A. Chatterjee, Kimberly A. Parks, Jagmeet P. Singh

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Purpose Optimal left ventricular (LV) lead position has emerged as an important determinant of response after cardiac resynchronization therapy (CRT). Comparatively, strategy for right ventricular (RV) lead optimization remains uncertain. Methods Three variations of RV lead position (apex, midseptal, and high septal) were tested in seven consecutive patients. At each location, intra-procedural measurement of LV lead electrical delay (LVLED) was obtained during intrinsic rhythm and RV pacing (RV-LVLED). Simultaneous cardiac output assessment was performed using the LiDCO™ (lithium chloride indicator dilution) system. Final RV lead location was selected based on best-measured cardiac output. Clinical and echocardiographic outcomes were assessed at baseline and 6 months. Results Adjustment of RV lead position after securing a LV lead site led to an incremental change of 30±18 % (range, 7-52 %) in the cardiac index (CI). There was substantial variation in acute hemodynamic response (ΔCI, 14±13 %; range, 3-41 %) seen with pacing from each patient's worst to best RV lead position; no single RV lead position emerged as optimal across all patients. Paced RV-LVLED was not correlated with percent change in CI (r=0.18; p= NS). LVejection fraction (LVEF) increased significantly (28 ±4 to 40±8 %, p=0.006) at 6 months. LVLED measured during intrinsic rhythm, but not during RV pacing, correlated with percent change in LVEF (r=0.88, p=0.02). Conclusions RV lead position adjustment can be used to enhance acute hemodynamic response during CRT. Measurement of paced RV-LVLED, however, does not reliably predict change in cardiac output.

Original languageEnglish
Pages (from-to)223-231
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Volume36
Issue number3
DOIs
StatePublished - Apr 2013
Externally publishedYes

Keywords

  • Cardiac resynchronization therapy
  • Hemodynamic response
  • Left ventricular lead electrical delay
  • Left ventricular lead position
  • Right ventricular lead position

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