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European Heart Journal Advance Access originally published online on February 7, 2009
European Heart Journal 2009 30(7):797-804; doi:10.1093/eurheartj/ehp011
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Pressure–volume loop analysis during implantation of biventricular pacemaker/cardiac resynchronization therapy device to optimize right and left ventricular pacing sites

Peter Paul H.M. Delnoy1,*, Jan Paul Ottervanger1, Henk Oude Luttikhuis1, Dick H.S. Vos1, Arif Elvan1, Anand R. Ramdat Misier1, Willem P. Beukema1, Paul Steendijk2 and Norbert M. van Hemel3

1 Department of Cardiology, Isala klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands
2 Departments of Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
3 Heart Lung Centre Utrecht, Utrecht University, Utrecht, The Netherlands

Received 30 July 2008; revised 21 October 2008; accepted 24 December 2008; online publish-ahead-of-print 7 February 2009.

* Corresponding author. Tel: +31 38 424 2374, Fax: +31 38 424 3733, Email: v.r.c.derks{at}isala.nl

Aims: To evaluate the clinical utility of pressure–volume loop analyses during pacemaker/implantable cardioverter defibrillator (ICD) implantations to assess the optimal right ventricular (RV) and/or left ventricular (LV) lead position.

Methods and results: 29 patients with heart failure and chronic RV apical pacing were studied. Stroke work (SW), LV ejection fraction (LVEF), cardiac output (CO), and LV dP/dtmax were assessed using a conductance catheter in the LV during RV apical, RV outflow tract, single-site LV, and biventricular pacing at different left-sided pacing locations. Left ventricular ejection fraction was 34.3 ± 9.8%. Compared with baseline, RV outflow tract pacing showed a small increase of 4.0 ± 6.4% in LV dP/dtmax and no improvement in SW, LVEF, or CO. In the optimal biventricular configuration, SW increased 39 ± 41%, LVEF increased 22 ± 13%, CO increased 16 ± 16%, and LV dP/dtmax increased 10 ± 11% (all P < 0.05). In 45% of the patients, the optimal LV lead position was found at a different location as the ‘first choice' postero-lateral or lateral target vein.

Conclusion: Pressure–volume loop analysis during pacemaker/ICD implantations facilitates to determine the optimal LV pacing site. Patients with chronic RV pacing showed a significant acute improvement in LV function when LV pacing or biventricular pacing is applied.

Key Words: Heart failure • Pacing • Biventricular pacing • Pressure–volume loops


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