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Variation in Optimal Haemodynamic Atrio-ventricular Delay of Biventricular Pacing with Different Endocardial Left Ventricular Lead Locations using Precision Haemodynamics
  • +16
  • Butcher CJT,
  • Emily Cantor,
  • Sohaib SMA,
  • Matthew Shun-Shin,
  • Ross Haynes,
  • Habib Khan,
  • Kyriacou A,
  • Rui Shi,
  • Zhong Chen,
  • Shouvik Haldar,
  • John Cleland,
  • Wajid Hussain,
  • Vias Markides,
  • David Jones,
  • Lane RE,
  • Mason MJ,
  • Zachary Whinnett,
  • Darrel Francis,
  • Wong T
Butcher CJT
Royal Brompton and Harefield Hospitals

Corresponding Author:[email protected]

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Emily Cantor
Royal Brompton and Harefield Hospitals
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Sohaib SMA
Royal Brompton and Harefield Hospitals
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Matthew Shun-Shin
Imperial College London
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Ross Haynes
Royal Brompton and Harefield Hospitals
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Habib Khan
Royal Brompton and Harefield Hospitals
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Kyriacou A
Sheffield Teaching Hospitals NHS Foundation Trust
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Rui Shi
Royal Brompton and Harefield Hospitals
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Zhong Chen
Royal Brompton and Harefield Hospitals
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Shouvik Haldar
Royal Brompton and Harefield Hospitals
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John Cleland
Imperial College London
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Wajid Hussain
Royal Brompton and Harefield Hospitals
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Vias Markides
Royal Brompton and Harefield Hospitals
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David Jones
Royal Brompton and Harefield Hospitals
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Lane RE
Royal Brompton and Harefield Hospitals
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Mason MJ
Royal Brompton and Harefield Hospitals
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Zachary Whinnett
Imperial College London
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Darrel Francis
Imperial College London
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Wong T
Royal Brompton and Harefield Hospitals
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Abstract

Background: It is not known whether the optimal Atrioventricular delay (AV opt) varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration. Methods: We assessed the haemodynamic AV opt in patients with chronic heart failure undergoing endocardial LV lead implantation. AV opt was assessed during atrio-biventricular pacing (BVP) with a “roving LV lead”. Up to four locations were studied: mid lateral wall, mid septum (or a close alternative), site of greatest haemodynamic improvement and LV lead implant site. The AV opt was compared to a fixed AV delay of 180ms. Results: Seventeen patients were included (12 male, aged 66.5 +/- 12.8 years, ejection fraction 26 +/- 7%, 16 left bundle branch block or high percentage of right ventricular pacing (RVP), QRS duration 167 +/-27 ms). In most locations (62/63), AV opt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, IQR 4-9mmHg). Compared to a fixed AV delay the haemodynamic improvement at AV opt was higher (1mmHg, IQR 0.2-2.6mmHg, p<0.001). Within most patients (16/17), we observed a difference in AV opt between pacing sites (median paced AV opt 209 ms, IQR 117-250). Within this range, the haemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6mmHg). Conclusion: Within a patient, different endocardial LV lead locations have slightly different haemodynamic AV opt which are superior to a fixed AV delay. The haemodynamic consequence of applying an optimum from a different lead location is small.
15 Jun 2022Submitted to Journal of Cardiovascular Electrophysiology
16 Jun 2022Submission Checks Completed
16 Jun 2022Assigned to Editor
21 Jun 2022Reviewer(s) Assigned
15 Sep 2022Review(s) Completed, Editorial Evaluation Pending
17 Sep 2022Editorial Decision: Revise Minor
16 Nov 20221st Revision Received
16 Nov 2022Review(s) Completed, Editorial Evaluation Pending
16 Nov 2022Submission Checks Completed
16 Nov 2022Assigned to Editor
16 Nov 2022Reviewer(s) Assigned
06 Jan 2023Editorial Decision: Revise Minor
14 Jan 20232nd Revision Received
14 Jan 2023Submission Checks Completed
14 Jan 2023Assigned to Editor
14 Jan 2023Review(s) Completed, Editorial Evaluation Pending
14 Jan 2023Reviewer(s) Assigned
05 Feb 2023Editorial Decision: Accept