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. 2023 Jun;34(6):1431-1440.
doi: 10.1111/jce.15862. Epub 2023 May 26.

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

Charles J T Butcher  1   2 , Emily Cantor  1   2 , Afzal Sohaib  1   2 , Matthew J Shun-Shin  2   3 , Ross Haynes  1 , Habib Khan  1   2 , Adreas Kyriacou  4 , Rui Shi  1 , Zhong Chen  1 , Shouvik Haldar  1 , John G F Cleland  2 , Wajid Hussain  1 , Vias Markides  1 , David G Jones  1 , Rebecca E Lane  1 , Mark J Mason  1 , Zachary I Whinnett  2   3 , Darrel P Francis  2   3 , Tom Wong  1   2
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Free article

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

Charles J T Butcher et al. J Cardiovasc Electrophysiol. 2023 Jun.
Free article

Abstract

Introduction: It is not known whether the optimal atrioventricular (AVopt ) delay varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration.

Methods: We assessed the hemodynamic AVopt in patients with chronic heart failure undergoing endocardial LV lead implantation. AVopt was assessed during atrio-BiVP with a "roving LV lead." Up to four locations were studied: mid-lateral wall, mid-septum (or a close alternative), site of greatest hemodynamic improvement, and LV lead implant site. The AVopt was compared to a fixed AV delay of 180 ms.

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), AVopt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, interquartile range [IQR] 4-9 mmHg). Compared to a fixed AV delay, the hemodynamic improvement at AVopt was higher (1 mmHg, IQR 0.2-2.6 mmHg, p < .001). Within most patients (16/17), we observed a difference in AVopt between pacing sites (median paced AVopt 209 ms, IQR 117-250). Within this range, the hemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6 mmHg).

Conclusion: Within a patient, different endocardial LV lead locations have slightly different hemodynamic AVopt which are superior to a fixed AV delay. The hemodynamic consequence of applying an optimum from a different lead location is small.

Keywords: atrioventricuar delay; cardiac resynchronization therapy; endocardial left ventricular lead; heart failure; hemodynamic optimization.

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References

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