Abstract 21322: Cardiac Resynchronization With Fusion Produce a Better Lv Resynchronization and Lv Systolic Function vs Atrio-Biventricular Pacing - An Acute Study
Background: Recent data showed that CRT with optimal fusion produce a better acute haemodinamic response and superior LV reverse remodeling.
Purpose: to explore the mechanisms of this superior response.
Methods: Speckle tracking radial strain was performed before and one week after implantation of a biventricular pace-maker in 20 CHF patients (LBBB, sinus rhythm, 9 ischemic etiology, 61±10 years, 9 women, baseline NYHA class 3.2±0.4, baseline LV ejection fraction 21±5%, baseline LV ESV 180±80 ml) with concordant LV lead position (LV segment with the latest peak strain concordant with LV lead position in LAO X-ray projection). Measurements at one week were done with the CRT device programmed consecutively to pace with optimal fusion (OPT) and atrio-biventricular (AbiV, VV=0 ms, with shortest AV interval that not truncate A wave). Mechanical intraventricular dyssynchrony was assessed as the time difference between peak strain of the earliest and latest LV segments from the 6 regional colorcoded time-strain curves. LV systolic performance was evaluated by dp/dt on the regurgitant flow at mitral valve and or aortic VTI.
Results: CRT with fusion produced a superior acute haemodinamic response: LV dp/dt 781±187 mmHg/s in OPT vs 730±164 mmHg/s in AbiV (p<0.05); aortic VTI 25.8±3 cm in OPT vs 24.8±2.6 cm in AbiV (p<0.02). This was associated with superior reduction in intraventricular dyssynchrony: 76±5 ms in OPT vs. 176±102 ms with AbiV (p<0.005).
Conclusions: CRT with optimal fusion in patients with concordant LV lead position produce a superior LV resynchronization and a better acute haemodinamical response than standard atrio-biventricular pacing.
- © 2010 by American Heart Association, Inc.