Synchronous Ventricular Pacing without Crossing the Tricuspid Valve or Entering the Coronary Sinus-Preliminary Results

Synchronous Ventricular Pacing without Crossing the Tricuspid Valve or Entering the Coronary Sinus-Preliminary Results

Autor Henz, Benhur D. Autor UNIFESP Google Scholar
Friedman, Paul A. Google Scholar
Bruce, Charles J. Google Scholar
Okumura, Yasuo Google Scholar
Johnson, Susan B. Google Scholar
Danielsen, Andrew Google Scholar
Packer, Douglas L. Google Scholar
Asirvatham, Samuel J. Google Scholar
Instituição Mayo Clin
Universidade Federal de São Paulo (UNIFESP)
Nihon Univ
Resumo Background: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV).Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony.Results: the lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. the QRS duration was less with AVS compared with RVA pacing (89 +/- 4 ms vs. 100 +/- 11 ms [P < 0.0001, GEE P = 0.03]). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 +/- 91 ms vs. 250 +/- 11 ms [P < 0.0001, GEE P = 0.006]). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 +/- 7.7 vs. 30.8 +/- 11.6 [P = 0.01, GEE P = 0.07]). the interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 +/- 6.4 ms vs. 31.1 +/- 11.7 ms [P = 0.005, GEE P = 0.02]).Conclusion: the AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV.(J Cardiovasc Electrophysiol, Vol. 20, pp. 1391-1397, December 2009).
Assunto atrioventricular septum
cardiomyopathy
dyssynchrony
pacemaker lead
tricuspid regurgitation
Idioma Inglês
Data 2009-12-01
Publicado em Journal of Cardiovascular Electrophysiology. Malden: Wiley-Blackwell Publishing, Inc, v. 20, n. 12, p. 1391-1397, 2009.
ISSN 1045-3873 (Sherpa/Romeo, fator de impacto)
Editor Wiley-Blackwell
Extensão 1391-1397
Fonte http://dx.doi.org/10.1111/j.1540-8167.2009.01556.x
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000272129600015
URI http://repositorio.unifesp.br/handle/11600/32008

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