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Resynchronization therapy optimization by intracardiac impedance.

Mario Bocchiardo1, Dorothee Meyer zu Vilsendorf, Carmelo Militello

  • 1Cardiology Division, Ospedale Cardinal Massaia, C.so Dante, 202, 14100 Asti, Italy.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|July 30, 2010
PubMed
Summary
This summary is machine-generated.

Intracardiac impedance measurement effectively optimizes cardiac resynchronization therapy (CRT) by adjusting left ventricular lead position and stimulation timing. This method shows performance comparable to traditional techniques, paving the way for automated CRT optimization.

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • Successful cardiac resynchronization therapy (CRT) requires precise optimization of left ventricular (LV) lead placement and stimulation timing.
  • Current optimization methods can be complex and time-consuming.

Purpose of the Study:

  • To evaluate the feasibility of using intracardiac impedance measurements for optimizing LV lead position, atrioventricular delay (AVd), and interventricular delay (VVd) in CRT.
  • To compare the performance of impedance-based optimization with established methods.

Main Methods:

  • 14 heart failure patients underwent biventricular (DDD-BiV) pacing with varied LV lead sites, AVd, and VVd.
  • Intracardiac impedance was measured alongside LV and aortic pressure using an external pacemaker and micromanometer catheter.
  • Key parameters like LV dP/dt(max), pulse pressure (PP), stroke volume (SV), end-systolic impedance (ESZ), and stroke impedance (SZ) were determined.

Main Results:

  • Optimization of LV lead site, AVd, and VVd using impedance (SZ) yielded significant benefits comparable to those achieved with SV and PP methods.
  • Impedance-based optimization demonstrated mean benefits of 17.2-21.8% for lead site, AVd, and VVd adjustments.
  • A strong correlation was observed between AVd values selected by the reference method (dP/dt(max)) and impedance-based methods.

Conclusions:

  • Intracardiac impedance measurement is a feasible method for optimizing LV lead site, AVd, and VVd in CRT patients.
  • The performance of impedance-based optimization is similar to that of stroke volume and pulse pressure methods.
  • Intracardiac impedance holds promise for future automatic, implant-based CRT optimization.