Usefulness of Cardiac Resynchronization Therapy in Patients With Continuous Flow Left Ventricular Assist Devices
Vlad Cotarlan1, Frances Johnson2, Jennifer Goerbig-Campbell2
1University of Cincinnati; University of Iowa.
The American Journal of Cardiology
|December 13, 2018
Summary
Biventricular (BiV) pacing offers no acute hemodynamic advantage over right ventricular (RV) pacing or intrinsic rhythm in patients with left ventricular assist devices (LVADs). Lower heart rates may improve right ventricular performance in this population.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- The role of cardiac resynchronization therapy (CRT) in patients with left ventricular assist devices (LVADs) remains unclear.
- Current guidelines do not specify pacemaker settings post-LVAD implantation.
Purpose of the Study:
- To evaluate the acute hemodynamic effects of biventricular (BiV) pacing compared to right ventricular (RV) pacing and intrinsic rhythm in LVAD patients.
Main Methods:
- Twenty-two LVAD patients with pre-implant BiV pacemakers underwent hemodynamic assessments.
- Measurements included right atrial pressure, pulmonary artery pressures, cardiac output, and right ventricular stroke work index under BiV pacing, RV pacing, and intrinsic rhythm.
Main Results:
- No significant hemodynamic differences were observed between BiV pacing and RV pacing or intrinsic rhythm.
- Hemodynamic parameters remained stable across heart rates from 50 to 110 beats/min.
- Right ventricular stroke work index decreased at higher heart rates, indicating reduced RV performance.
Conclusions:
- Biventricular pacing does not provide acute hemodynamic benefits in LVAD patients compared to RV pacing or intrinsic rhythm.
- Maintaining a lower heart rate may be beneficial for optimizing right ventricular function in this cohort.
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