Synchronous ventricular pacing without crossing the tricuspid valve or entering the coronary sinus - Preliminary results: Experimental

Benhur D. Henz, Paul Andrew Friedman, Charles J Bruce, Yasuo Okumura, Susan B. Johnson, Andrew Danielsen, Douglas L Packer, Samuel J Asirvatham

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Atrioventricular Septal Pacing. Background: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV). Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony. Results: The lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. The QRS duration was less with AVS compared with RVA pacing (89 ± 4 ms vs. 100 ± 11 ms P < 0.0001, GEE P = 0.03). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 ± 91 ms vs. 250 ± 11 ms P < 0.0001, GEE P = 0.006). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 ± 7.7 vs. 30.8 ± 11.6 P = 0.01, GEE P = 0.07). The interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 ± 6.4 ms vs. 31.1 ± 11.7 ms P = 0.005, GEE P = 0.02). Conclusion: The AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1391-1397, December 2009)

Original languageEnglish (US)
Pages (from-to)1391-1397
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number12
DOIs
StatePublished - Dec 2009

Fingerprint

Tricuspid Valve
Coronary Sinus
Dogs
Ventricular Dysfunction
Ventricular Septum
Tricuspid Valve Insufficiency
Echocardiography
Myocardium
Color
Lead

Keywords

  • Atrioventricular septum
  • Cardiomyopathy
  • Dyssynchrony
  • Pacemaker lead
  • Tricuspid regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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title = "Synchronous ventricular pacing without crossing the tricuspid valve or entering the coronary sinus - Preliminary results: Experimental",
abstract = "Atrioventricular Septal Pacing. Background: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV). Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony. Results: The lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. The QRS duration was less with AVS compared with RVA pacing (89 ± 4 ms vs. 100 ± 11 ms P < 0.0001, GEE P = 0.03). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 ± 91 ms vs. 250 ± 11 ms P < 0.0001, GEE P = 0.006). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 ± 7.7 vs. 30.8 ± 11.6 P = 0.01, GEE P = 0.07). The interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 ± 6.4 ms vs. 31.1 ± 11.7 ms P = 0.005, GEE P = 0.02). Conclusion: The AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1391-1397, December 2009)",
keywords = "Atrioventricular septum, Cardiomyopathy, Dyssynchrony, Pacemaker lead, Tricuspid regurgitation",
author = "Henz, {Benhur D.} and Friedman, {Paul Andrew} and Bruce, {Charles J} and Yasuo Okumura and Johnson, {Susan B.} and Andrew Danielsen and Packer, {Douglas L} and Asirvatham, {Samuel J}",
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T1 - Synchronous ventricular pacing without crossing the tricuspid valve or entering the coronary sinus - Preliminary results

T2 - Experimental

AU - Henz, Benhur D.

AU - Friedman, Paul Andrew

AU - Bruce, Charles J

AU - Okumura, Yasuo

AU - Johnson, Susan B.

AU - Danielsen, Andrew

AU - Packer, Douglas L

AU - Asirvatham, Samuel J

PY - 2009/12

Y1 - 2009/12

N2 - Atrioventricular Septal Pacing. Background: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV). Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony. Results: The lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. The QRS duration was less with AVS compared with RVA pacing (89 ± 4 ms vs. 100 ± 11 ms P < 0.0001, GEE P = 0.03). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 ± 91 ms vs. 250 ± 11 ms P < 0.0001, GEE P = 0.006). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 ± 7.7 vs. 30.8 ± 11.6 P = 0.01, GEE P = 0.07). The interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 ± 6.4 ms vs. 31.1 ± 11.7 ms P = 0.005, GEE P = 0.02). Conclusion: The AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1391-1397, December 2009)

AB - Atrioventricular Septal Pacing. Background: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV). Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony. Results: The lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. The QRS duration was less with AVS compared with RVA pacing (89 ± 4 ms vs. 100 ± 11 ms P < 0.0001, GEE P = 0.03). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 ± 91 ms vs. 250 ± 11 ms P < 0.0001, GEE P = 0.006). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 ± 7.7 vs. 30.8 ± 11.6 P = 0.01, GEE P = 0.07). The interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 ± 6.4 ms vs. 31.1 ± 11.7 ms P = 0.005, GEE P = 0.02). Conclusion: The AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1391-1397, December 2009)

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KW - Pacemaker lead

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