LEFT VENTRICULAR PACING VECTOR OPTIMIZATION IN CARDIAC RESYNCHRONIZATION THERAPY – INSIGHTS FROM SONR SENSOR BASED ACUTE HEMODYNAMIC MEASUREMENTS
K.J. Gutleben, F. Koch, S. Molatta, B. Körber, C. Becker, F. Ziglio, M. Wallich, D. Horstkotte, G. Nölker
1. Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany; 2. orin Group, Saluggia, Italy; 3. Sorin Group, Munich, Germany
Background: Cardiac resynchronization therapy (CRT) effect varies with different left ventricular (LV) pacing vectors (PV). Peak endocardial acceleration (PEA or SonR) signals have been used successfully for automatic hemodynamic CRT optimization. We evaluated hemodynamic effects of different LV PV using device derived SonR signals.
Methods: Patients (pts) implanted with a CRT system featuring SonR signal management (ParadymRF SonR, Sorin, France) were included. After automatic timing optimization with each PV (Bipolar, LV tip-RV ring, LV ring-RV coil), SonR signals were registered. SonR Area Index (SAI) was calculated for each PV. The optimal PV presenting the highest SAI was determined.
Results: Twenty nine data sets were obtained from 18 pts (10 male, NYHA III, EF 29±6 %, QRS 151±25 ms, 64±6 years). SAI values in best and worst PV differed significantly (0.7±0.5 vs 0.6±0.3, p=0.0003) with a maximal increase of 62% (Fig1). Nineteen (66%) data sets showed differences above 10%. 10 of 11 (91%) follow-up measurements revealed the same optimal PV compared to baseline.
Conclusions: Hemodynamic response to CRT can be optimized by selection of the PV. The optimal PV seems to be stable over time.
