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Transesophageal left ventricular electrogram-recording and temporary pacing to improve patient selection for cardiac resynchronization

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Abstract

Cardiac resynchronization therapy (CRT) with biventricular pacing (BV) is an established therapy for heart failure (HF) patients with inter- and intraventricular conduction delay. The aim of this pilot study was to test the feasibility of both transesophageal measurement of left ventricular (LV) electrical delay and transesophageal LV pacing prior to implantation, to better select patients for CRT. Esophageal TO8 Osypka catheter was perorally applied in 30 HF patients in position of maximum LV deflection to measure LV electrical delay and to study arterial pulse pressure (PP) during transesophageal bipolar LV pacing. There were 15 responders with a PP increase of a mean 65 ± 24 mmHg to 79 ± 27 mmHg (P < 0.001) and a mean LV electrical delay of 86.8 ± 33 ms. The 15 non-responders with poor PP increase of a mean 63.5 ± 23.5 mmHg to 64.1 ± 23.9 mmHg (P = 0.065) had a significantly smaller LV electrical delay of 36 ± 21 ms (P < 0.001). During a 34 ± 26 month CRT follow-up, the responders New York Heart Association (NYHA) class improved from 3.1 ± 0.35 to 2.1 ± 0.35 (P < 0.001). Determination of left ventricular electrical delay by transesophageal electrogram recording and transesophageal left ventricular pacing may be additional useful techniques to improve patient selection for CRT.

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References

  1. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J, MIRACLE Study Group (2002) Multicenter InSync randomized clinical evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med 346(24):1845–1853

    Article  PubMed  Google Scholar 

  2. American Society of Echocardiography, Committee on Standards (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 2:338–367

    Google Scholar 

  3. Auricchio A, Stellbrink C, Block M, Sack S, Vogt J, Bakker P, Klein H, Kramer A, Ding J, Salo R, Tockman B, Pochet T, Spinelli J (1999) Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation 99:2993–3001

    PubMed  CAS  Google Scholar 

  4. Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Huth C, Schöndube F, Wolfhard U, Böcker D, Krahnefeld O, Kirkels H, Pacing Therapies in Congestive Heart Failure (PATH-CHF) Study Group (2002) Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 39(12):2026–2033

    Article  PubMed  Google Scholar 

  5. Auricchio A, Ding J, Spinelli JC, Kramer AP, Salo RW, Hoersch W, KenKnight BH, Klein HU (2002) Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay. J Am Coll Cardiol 39:1163–1169

    Article  PubMed  Google Scholar 

  6. Bilge AK, Ozben B, Ozyigit T, Acar D, Hunerel D, Adalet K, Nisanci Y (2008) Assessment of early changes in the segmental functions of the left and the right ventricles after biventricular pacing in heart failure: a study with tissue Doppler imaging. Angiology 59(2):179–184

    Article  PubMed  Google Scholar 

  7. Breithardt OA, Stellbrink C, Kramer AP, Sinha AM, Franke A, Salo R, Schiffgens B, Huvelle E, Auricchio A, PATH-CHF Study Group. Pacing Therapies for Congestive Heart Failure (2002) Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy. J Am Coll Cardiol 40:536–545

    Article  PubMed  Google Scholar 

  8. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM, for the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350(21):2140–2150

    Article  PubMed  CAS  Google Scholar 

  9. Butter C, Auricchio A, Stellbrink C, Fleck E, Ding J, Yu Y, Huvelle E, Spinelli J, Pacing Therapy for Chronic Heart Failure II Study Group (2001) Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 104(25):3026–3029

    Article  PubMed  CAS  Google Scholar 

  10. Cazeau S, Gras D, Lazarus A, Ritter P, Mugica J (2000) Multisite stimulation for correction of cardiac asynchrony. Heart 84:579–581

    Article  PubMed  CAS  Google Scholar 

  11. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC, Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators (2001) Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344(12):873–880

    Article  PubMed  CAS  Google Scholar 

  12. Cazeau S, Alonso C, Jauvert G, Lazarus A, Ritter P (2004) Cardiac resynchronization therapy. Europace 5(Suppl 1):S42–S48

    Article  PubMed  Google Scholar 

  13. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L, Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352(15):1539–1549

    Article  PubMed  CAS  Google Scholar 

  14. Duray GZ, Israel CW, Pajitnev D, Hohnloser SH (2008) Upgrading to biventricular pacing/defibrillation systems in right ventricular paced congestive heart failure patients: prospective assessment of procedural parameters and response rate. Europace 10(1):48–52

    Article  PubMed  Google Scholar 

  15. Heinke M, Volkmann H (1992) Balloon electrode catheter for transesophageal atrial pacing and transesophageal ECG recording. Pacing Clin Electrophysiol 15:1953–1956

    Article  PubMed  CAS  Google Scholar 

  16. Heinke M, Kühnert H, Volkmann H, Butkewitz F, Müller S (1994) Esophageal balloon electrode catheter for transthoracic recording of His-bundle potential with transesophageal atrial pacing. Pacing Clin Electrophysiol 17:2125–2128

    Article  PubMed  CAS  Google Scholar 

  17. Heinke M, Surber R, Kühnert H, Dannberg G, Schwarz G, Figulla HR (2005) Transoesophageal left ventricular pacing in heart failure patients with permanent right ventricular pacing. Europace 7:617–620

    Article  PubMed  Google Scholar 

  18. Heinke M, Surber R, Kühnert H, Dannberg G, Prochnau D, Figulla HR (2007) Transesophageal left ventricular posterior wall potential in heart failure patients with biventricular pacing. Biomed Techn 52:173–179

    Article  Google Scholar 

  19. Heinke M, Kühnert H, Surber R, Osypka P, Gerstmann H, Haueisen J, Heinke T, Reinhard D, Prochnau D, Dannberg G, Figulla HR (2007) Termination of atrial flutter by directed transesophageal atrial pacing during transesophageal echocardiography. Biomed Techn 52:180–184

    Article  Google Scholar 

  20. Ismer B, Körber T, von Knorre GH, Voss W, Weber F, Wohlfahrt J, Minden HH, Nienaber CA (2004) Utilization of PMS1000 programmer to optimize the AV delay in biventricular pacing systems irrespective of make and model, vol 7. Medimond S.r.l. Bologna, Italy, pp 25–31. ISBN 88-7587-141-8

  21. Ismer B, Körber T, von Knorre GH, Voss W, Burska D, Nienaber CA (2006) Left ventricular electromechanical latency period is an additional indicator to upgrade from right to biventricular DDD pacing. Herzschrittmacherther Elektrophysiol 17(Suppl 1):I37–I41

    Article  PubMed  Google Scholar 

  22. Molhoek SG, Bax JJ, van Erven L, Bootsma M, Boersma E, Steendijk P, van der Wall EE, Schalij MJ (2002) Effectiveness of resynchronization therapy in patients with end-stage heart failure. Am J Cardiol 90:379–383

    Article  PubMed  Google Scholar 

  23. Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, Kass DA (2000) Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle branch block. Circulation 102:3053–3059

    PubMed  CAS  Google Scholar 

  24. Penicka M, Bartunek J, De Bruyne B, Vanderheyden M, Goethals M, De Zutter M, Brugada P, Geelen P (2004) Improvement of left ventricular function after cardiac resynchronisation therapy is predicted by tissue Doppler imaging echocardiography. Circulation 109(8):978–983

    Article  PubMed  Google Scholar 

  25. Reddy VY, Neuzil P, Taborsky M, Kralovec S, Sediva L, Ruskin JN (2003) Electroanatomic mapping of cardiac resynchronization therapy. Circulation 107(21):2761–2763

    Article  PubMed  Google Scholar 

  26. Saxon LA, De Marco T, Schafer J, Chatterjee K, Kumar UN, Foster E, VIGOR Congestive Heart Failure Investigators (2002) Effects of long-term biventricular stimulation for resynchronization on echocardiographic measures of remodelling. Circulation 105(11):1304–1310

    Article  PubMed  Google Scholar 

  27. Turner MS, Bleasdale RA, Vinereanu D, Mumford CE, Paul V, Fraser AG, Frenneaux MP (2004) Electrical and mechanical components of dyssynchrony in heart failure patients with normal QRS duration and left bundle-branch block: impact of left and biventricular pacing. Circulation 109(21):2544–2549

    Article  PubMed  Google Scholar 

  28. Valzania C, Rocchi G, Biffi M, Martignani C, Bertini M, Diemberger I, Biagini E, Ziacchi M, Domenichini G, Saporito D, Rapezzi C, Branzi A, Boriani G (2008) Left ventricular versus biventricular pacing: a randomized comparative study evaluating mid-term electromechanical and clinical effects. Echocardiography 25(2):141–148

    Article  PubMed  Google Scholar 

  29. van Dijk J, Knaapen P, Russel IK, Hendriks T, Allaart CP, de Cock CC, Kamp O (2008) Mechanical dyssynchrony by 3D echo correlates with acute haemodynamic response to biventricular pacing in heart failure patients. Europace 10(1):63–68

    Article  PubMed  Google Scholar 

  30. Willerson JT, Kereiakes DJ (2004) Cardiac resynchronization therapy helpful now in selected patients with CHF. Circulation 109(3):308–309

    Article  PubMed  Google Scholar 

  31. Yu CM, Fung JW, Zhang Q, Chan CK, Chan YS, Lin H, Kum LC, Kong SL, Zhang Y, Sanderson JE (2004) Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy. Circulation 110(1):66–73

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors gratefully thank Prof. Dr. med. Georg H. von Knorre (University Hospital Rostock, Division of Cardiology, Germany), PD Dr. med. Ralf Surber (University Hospital Jena, Division of Cardiology, Germany) for helpful discussions and Jim Schwartz for manuscript revision.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine I, Friedrich Schiller University of Jena, Erlanger Allee 101, 07740, Jena, Germany

    Matthias Heinke, Helmut Kühnert & Hans R. Figulla

  2. Offenburg University of Applied Sciences, Badstraße 24, 77652, Offenburg, Germany

    Bruno Ismer

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  1. Matthias Heinke
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  2. Bruno Ismer
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  3. Helmut Kühnert
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  4. Hans R. Figulla
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Correspondence to Matthias Heinke.

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Heinke, M., Ismer, B., Kühnert, H. et al. Transesophageal left ventricular electrogram-recording and temporary pacing to improve patient selection for cardiac resynchronization. Med Biol Eng Comput 49, 851–858 (2011). https://doi.org/10.1007/s11517-011-0767-6

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  • DOI: https://doi.org/10.1007/s11517-011-0767-6

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