Usefulness of Cardiac Resynchronization Therapy in Patients With Continuous Flow Left Ventricular Assist Devices
The benefit of cardiac resynchronization therapy in patients supported by a left ventricular assist device (LVAD) is unknown. There are currently no guidelines regarding the continuation, discontinuation or pacemaker (PM) settings post-LVAD implant. The aim of the study was to assess the hemodynamic...
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| Veröffentlicht in: | The American journal of cardiology 2019-01, Vol.123 (1), p.93-99 |
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| creator | Cotarlan, Vlad Johnson, Frances Goerbig-Campbell, Jennifer Light-McGroary, KellyAnn Inampudi, Chakradhari Franzwa, Jennifer Jenn, Kyle Johnson, Carol Tandon, Rudhir Tahir, Rizwan Nabeel, Yassar Emerenini, Uzodinma Giudici, Michael |
| description | The benefit of cardiac resynchronization therapy in patients supported by a left ventricular assist device (LVAD) is unknown. There are currently no guidelines regarding the continuation, discontinuation or pacemaker (PM) settings post-LVAD implant. The aim of the study was to assess the hemodynamic benefit of biventricular (BiV) pacing in LVAD patients. We studied 22 patients supported by LVADs (age 62 ± 9, 21 males) who had received a BiV PM before LVAD implant. A total of 123 complete sets of hemodynamics were obtained during BiV pacing (n = 54), right ventricular (RV) pacing (n = 54), and intrinsic rhythm (n = 15).
There were no significant differences in right atrial (RA) pressure, mean pulmonary artery pressure (mPA), PCWP, cardiac output, PA saturation (PASat) and right ventricular stroke work index between BiV and RV pacing. Hemodynamics obtained during intrinsic rhythm in 15 non–PM-dependent patients were not significantly different compared with those obtained during BiV or RV pacing. Furthermore, hemodynamics were similar at different heart rates ranging 50 to 110 beats/min. Right ventricular stroke work index was significantly lower at the highest heart rate compared with baseline and lowest heart rates suggesting decreased RV performance at higher heart rate. In conclusion, BiV pacing does not have any acute hemodynamic benefit compared with RV pacing or intrinsic rhythm in LVAD patients. A lower heart rate may confer better RV performance. |
| doi_str_mv | 10.1016/j.amjcard.2018.09.022 |
| format | Article |
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There were no significant differences in right atrial (RA) pressure, mean pulmonary artery pressure (mPA), PCWP, cardiac output, PA saturation (PASat) and right ventricular stroke work index between BiV and RV pacing. Hemodynamics obtained during intrinsic rhythm in 15 non–PM-dependent patients were not significantly different compared with those obtained during BiV or RV pacing. Furthermore, hemodynamics were similar at different heart rates ranging 50 to 110 beats/min. Right ventricular stroke work index was significantly lower at the highest heart rate compared with baseline and lowest heart rates suggesting decreased RV performance at higher heart rate. In conclusion, BiV pacing does not have any acute hemodynamic benefit compared with RV pacing or intrinsic rhythm in LVAD patients. A lower heart rate may confer better RV performance.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2018.09.022</identifier><identifier>PMID: 30539750</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Blood pressure ; Cardiac output ; Continuous flow ; Electrocardiography ; Heart failure ; Heart rate ; Hemodynamics ; Intubation ; Laboratories ; Males ; Patients ; Pressure ; Pulmonary arteries ; Pulmonary artery ; Rhythm ; Stroke ; Therapy ; Transplants & implants ; Ventricle ; Ventricular assist devices</subject><ispartof>The American journal of cardiology, 2019-01, Vol.123 (1), p.93-99</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Jan 1, 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-b1b14b65773ee6ba8aba579547b909b2a02a06602f029687a10b64011ceac7473</citedby><cites>FETCH-LOGICAL-c393t-b1b14b65773ee6ba8aba579547b909b2a02a06602f029687a10b64011ceac7473</cites><orcidid>0000-0002-6027-8843</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914918318435$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30539750$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cotarlan, Vlad</creatorcontrib><creatorcontrib>Johnson, Frances</creatorcontrib><creatorcontrib>Goerbig-Campbell, Jennifer</creatorcontrib><creatorcontrib>Light-McGroary, KellyAnn</creatorcontrib><creatorcontrib>Inampudi, Chakradhari</creatorcontrib><creatorcontrib>Franzwa, Jennifer</creatorcontrib><creatorcontrib>Jenn, Kyle</creatorcontrib><creatorcontrib>Johnson, Carol</creatorcontrib><creatorcontrib>Tandon, Rudhir</creatorcontrib><creatorcontrib>Tahir, Rizwan</creatorcontrib><creatorcontrib>Nabeel, Yassar</creatorcontrib><creatorcontrib>Emerenini, Uzodinma</creatorcontrib><creatorcontrib>Giudici, Michael</creatorcontrib><title>Usefulness of Cardiac Resynchronization Therapy in Patients With Continuous Flow Left Ventricular Assist Devices</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The benefit of cardiac resynchronization therapy in patients supported by a left ventricular assist device (LVAD) is unknown. There are currently no guidelines regarding the continuation, discontinuation or pacemaker (PM) settings post-LVAD implant. The aim of the study was to assess the hemodynamic benefit of biventricular (BiV) pacing in LVAD patients. We studied 22 patients supported by LVADs (age 62 ± 9, 21 males) who had received a BiV PM before LVAD implant. A total of 123 complete sets of hemodynamics were obtained during BiV pacing (n = 54), right ventricular (RV) pacing (n = 54), and intrinsic rhythm (n = 15).
There were no significant differences in right atrial (RA) pressure, mean pulmonary artery pressure (mPA), PCWP, cardiac output, PA saturation (PASat) and right ventricular stroke work index between BiV and RV pacing. Hemodynamics obtained during intrinsic rhythm in 15 non–PM-dependent patients were not significantly different compared with those obtained during BiV or RV pacing. Furthermore, hemodynamics were similar at different heart rates ranging 50 to 110 beats/min. Right ventricular stroke work index was significantly lower at the highest heart rate compared with baseline and lowest heart rates suggesting decreased RV performance at higher heart rate. In conclusion, BiV pacing does not have any acute hemodynamic benefit compared with RV pacing or intrinsic rhythm in LVAD patients. A lower heart rate may confer better RV performance.</description><subject>Blood pressure</subject><subject>Cardiac output</subject><subject>Continuous flow</subject><subject>Electrocardiography</subject><subject>Heart failure</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Intubation</subject><subject>Laboratories</subject><subject>Males</subject><subject>Patients</subject><subject>Pressure</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Rhythm</subject><subject>Stroke</subject><subject>Therapy</subject><subject>Transplants & implants</subject><subject>Ventricle</subject><subject>Ventricular assist 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Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cotarlan, Vlad</au><au>Johnson, Frances</au><au>Goerbig-Campbell, Jennifer</au><au>Light-McGroary, KellyAnn</au><au>Inampudi, Chakradhari</au><au>Franzwa, Jennifer</au><au>Jenn, Kyle</au><au>Johnson, Carol</au><au>Tandon, Rudhir</au><au>Tahir, Rizwan</au><au>Nabeel, Yassar</au><au>Emerenini, Uzodinma</au><au>Giudici, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Usefulness of Cardiac Resynchronization Therapy in Patients With Continuous Flow Left Ventricular Assist Devices</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>123</volume><issue>1</issue><spage>93</spage><epage>99</epage><pages>93-99</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>The benefit of cardiac resynchronization therapy in patients supported by a left ventricular assist device (LVAD) is unknown. There are currently no guidelines regarding the continuation, discontinuation or pacemaker (PM) settings post-LVAD implant. The aim of the study was to assess the hemodynamic benefit of biventricular (BiV) pacing in LVAD patients. We studied 22 patients supported by LVADs (age 62 ± 9, 21 males) who had received a BiV PM before LVAD implant. A total of 123 complete sets of hemodynamics were obtained during BiV pacing (n = 54), right ventricular (RV) pacing (n = 54), and intrinsic rhythm (n = 15).
There were no significant differences in right atrial (RA) pressure, mean pulmonary artery pressure (mPA), PCWP, cardiac output, PA saturation (PASat) and right ventricular stroke work index between BiV and RV pacing. Hemodynamics obtained during intrinsic rhythm in 15 non–PM-dependent patients were not significantly different compared with those obtained during BiV or RV pacing. Furthermore, hemodynamics were similar at different heart rates ranging 50 to 110 beats/min. Right ventricular stroke work index was significantly lower at the highest heart rate compared with baseline and lowest heart rates suggesting decreased RV performance at higher heart rate. In conclusion, BiV pacing does not have any acute hemodynamic benefit compared with RV pacing or intrinsic rhythm in LVAD patients. A lower heart rate may confer better RV performance.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30539750</pmid><doi>10.1016/j.amjcard.2018.09.022</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6027-8843</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Blood pressure Cardiac output Continuous flow Electrocardiography Heart failure Heart rate Hemodynamics Intubation Laboratories Males Patients Pressure Pulmonary arteries Pulmonary artery Rhythm Stroke Therapy Transplants & implants Ventricle Ventricular assist devices |
| title | Usefulness of Cardiac Resynchronization Therapy in Patients With Continuous Flow Left Ventricular Assist Devices |
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