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Updated: May 27, 2026
Optocardiography and Electrophysiology Studies of Ex Vivo Langendorff-perfused Hearts
Published on: November 7, 2019
The acute hemodynamic response to LV pacing within individual branches of the coronary sinus using a quadripolar lead
Anoop K Shetty1, Simon G Duckett, Ying Liang Ma
1Guys and St Thomas' Hospital NHS Foundation Trust King's College London, London, UK. anoop.shetty@kcl.ac.uk
Insights
The acute hemodynamic response (AHR) to left ventricle (LV) pacing varies slightly within coronary sinus (CS) branches. However, the specific position within a CS branch is less critical than selecting the correct CS vein for optimal LV lead placement.
Area of Science:
- Cardiovascular Electrophysiology
- Cardiac Pacing
- Hemodynamics
Background:
- The acute hemodynamic response (AHR) to left ventricle (LV) pacing via coronary sinus (CS) leads can vary.
- Optimal LV lead placement is crucial for effective cardiac resynchronization therapy.
- The impact of pacing within different regions of the same CS vein on AHR is not well understood.
Purpose of the Study:
- To evaluate the acute hemodynamic response (AHR) to left ventricle (LV) pacing at different sites within the coronary sinus (CS).
- To determine if pacing location within individual CS branches significantly affects AHR.
- To compare AHR across various pacing vectors and positions within the CS.
Main Methods:
- An acute hemodynamic study was conducted in 20 patients undergoing LV lead implantation.
- A Quartet LV lead with four electrodes was used to pace from multiple positions within CS branches.
- Acute hemodynamic response was assessed using three bipolar configurations, comparing different vectors and positions within each patient.
Main Results:
- Sixty-four pacing positions across 19 patients were analyzed.
- No significant overall difference in AHR was observed between the three tested pacing vectors.
- A small mean difference in AHR (+6.5%) was found between the lowest and highest dP/dt(max) across CS branch vectors.
- A larger difference in AHR (+16.9%) was noted when comparing the highest and lowest values achieved using any vector in any position within the same patient.
Conclusions:
- Pacing within different branches of the same coronary sinus (CS) yields a small difference in acute hemodynamic response (AHR).
- The specific pacing site within a CS branch is less critical than the choice of the CS vein itself for LV lead placement.
- These findings emphasize the importance of selecting the appropriate CS vein for optimal LV lead positioning and therapeutic effect.
Background:
It is not clear whether there is a large difference in acute hemodynamic response (AHR) to left ventricle (LV) pacing in different regions of the same coronary sinus (CS) vein. Using the four electrodes available on a Quartet LV lead, we evaluated the AHR to pacing within individual branches of the CS.
Methods:
An acute hemodynamic study was attempted in 20 patients. In each patient, we assessed AHR in a number of CS veins and along a significant proportion of each CS branch using three different bipolar configurations. We compared the AHR achieved when pacing using each different vector and also the highest AHR achieved in any position within the same patient with the lowest achieved in that patient.
Results:
Sixty-four different CS positions in 19 patients were successfully assessed. No significant difference in AHR was found overall between the three vectors tested. The mean percentage difference in AHR between the CS branch vectors with the lowest and highest dP/dt(max) was +6.5 ± 5.4% (P < 0.001). A much larger difference of +16.9 ± 6.1% (P < 0.001) was seen when comparing the highest and lowest AHR achieved using any vector in any position within the same patient.
Conclusion:
A small difference in AHR is seen when pacing within the same branch of the CS compared to pacing in different branches in the same patient. This suggests that although the site of LV lead placement is important, the position within a CS branch is less important than choosing the right vein.
