TY - JOUR
T1 - Vectorcardiography for optimization of stimulation intervals in cardiac resynchronization therapy
AU - van Deursen, Caroline J M
AU - Wecke, Liliane
AU - van Everdingen, Wouter M
AU - Ståhlberg, Marcus
AU - Janssen, Michel H G
AU - Braunschweig, Frieder
AU - Bergfeldt, Lennart
AU - Crijns, Harry J G M
AU - Vernooy, Kevin
AU - Prinzen, Frits W
PY - 2015
Y1 - 2015
N2 - Current optimization of atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) is time consuming and subject to noise. We aimed to prove the principle that the best hemodynamic effect of CRT is achieved by cancelation of opposing electrical forces, detectable from the QRS morphology in the 3D vectorcardiogram (VCG). Different degrees of left (LV) and right ventricular (RV) pre-excitation were induced, using variation in AV intervals during LV pacing in 20 patients with left bundle branch block (LBBB) and variation in VV intervals during biventricular pacing in 18 patients with complete AV block or atrial fibrillation. The smallest QRS vector area identified stimulation intervals with minimal systolic stretch (median difference [IQR] 20 ms [-20, 20 ms] and maximal hemodynamic response (10 ms [-20, 40 ms]). Reliability of VCG measurements was superior to hemodynamic measurements. This study proves the principle that VCG analysis may allow easy and reliable optimization of stimulation intervals in CRT patients.
AB - Current optimization of atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) is time consuming and subject to noise. We aimed to prove the principle that the best hemodynamic effect of CRT is achieved by cancelation of opposing electrical forces, detectable from the QRS morphology in the 3D vectorcardiogram (VCG). Different degrees of left (LV) and right ventricular (RV) pre-excitation were induced, using variation in AV intervals during LV pacing in 20 patients with left bundle branch block (LBBB) and variation in VV intervals during biventricular pacing in 18 patients with complete AV block or atrial fibrillation. The smallest QRS vector area identified stimulation intervals with minimal systolic stretch (median difference [IQR] 20 ms [-20, 20 ms] and maximal hemodynamic response (10 ms [-20, 40 ms]). Reliability of VCG measurements was superior to hemodynamic measurements. This study proves the principle that VCG analysis may allow easy and reliable optimization of stimulation intervals in CRT patients.
KW - Cardiac resynchronization therapy
KW - Biventricular pacing
KW - Vectorcardiography
KW - Electrocardiography
KW - Atrioventricular timing
KW - Interventricular timing
U2 - 10.1007/s12265-015-9615-7
DO - 10.1007/s12265-015-9615-7
M3 - Article
C2 - 25743446
SN - 1937-5387
VL - 8
SP - 128
EP - 137
JO - Journal of Cardiovascular Translational Research
JF - Journal of Cardiovascular Translational Research
IS - 2
ER -