Identification of the Right Ventricular Pacing Site for Cardiac Resynchronization Therapy (CRT) Guided by Electroanatomical Mapping (CARTO)
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概要
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Background The optimal left ventricle (LV) pacing site for cardiac resynchronization therapy (CRT) has been investigated, but less is known about the optimal site in the right ventricle (RV). The present study examined whether electrical resynchronization guided by electroanatomical mapping (CARTO) results in mechanical resynchronization. Methods and Results The study group included 13 patients indicated for CRT : 10 with nonischemic cardiomyopathy, 2 with ischemic cardiomyopathy and 1 with cardiac sarcoidosis, (mean LV ejection fraction : 32±10%). CARTO of the RV septum was performed to identify the site with the most delayed conduction time during LV pacing. Hemodynamic measurements were performed during conventional biventricular pacing with the RV apex and LV (C-BVP) and during biventricular pacing with the most delayed site of the RV (d-RV) and LV (D-BVP). Lead placement at 15 coronary sinus veins was examined in the 13 patients. During pacing from anterolateral veins (n=2), the d-RV was the RV apex (RVA) in 1 patient and the mid-septum in the other. During pacing from lateral veins (n=9), the d-RV comprised the RVA (n=3), the mid-septum (n=5), and the right ventricular outflow tract (RVOT) (n=1). During pacing from the posterolateral veins (n=3), the d-RV was the RVOT in all cases. In 11 of 15 sites, d-RV differed from conventional RVA. Compared with C-BVP, D-BVP produced a significant improvement in LV dp/dt. Furthermore, RV mid-septum and LV pacing markedly increased LV dp/dt and pulse pressure (PP), but RVOT and LV pacing did not. D-BVP vs C-BVP : %LV dp/dt 30±20 and 15±15%, p<0.05 ; RV mid-septum and LV pacing vs C-BVP : %LV dp/dt 35±20 and 10±15%, p<0.02, and vs PP 33±20 and 10±29mmHg, p<0.02. Conclusions For pacing from the LV lateral vein, potential improvement of cardiac performance compared with that by conventional RVA placement may be realized with concomitant pacing from the d-RV (mid-septum).
- 社団法人日本循環器学会の論文
- 2007-09-20
著者
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Yoshida Akihiro
Division of Cardiovascular Medicine, Himeji Cardiovascular Center
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Fukuzawa Kouji
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe Universit
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Hirata Kenichi
Division of Cardiovascular and Respiratory Medicine, Kobe University Graduate School of Medicine
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Kanda Gaku
Division Of Cardiovascular Medicine Department Of Internal Medicine Kobe University Graduate School
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Fukuzawa Kouji
Division Of Cardiovascular Medicine Department Of Internal Medicine Kobe University Graduate School
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TAKAMI Kaoru
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate Schoo
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Fukuzawa Koji
Kobe University Graduate School of Medicine
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Yoshida Akihiro
Kobe University Graduate School of Medicine
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Hirata Kenichi
Division Of Cardiovascular Medicine Department Of Internal Medicine Kobe University Graduate School
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Kiuchi Kunihiko
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe Universit
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Takano Takatsuna
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe Universit
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Fukuzawa Koji
Division Of Cardiovascular Medicine Department Of Internal Medicine Kobe University Graduate School
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Takami Kaoru
Division Of Cardiovascular Medicine Department Of Internal Medicine Kobe University Graduate School
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Yoshida Akihiro
Department Of Cardiology Kobe University Graduated School Of Medicine
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Yoshida Akihiro
Division Of Cardiology Department Of Internal Medicine St. Marianna University School Of Medicine
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Hirata Kenichi
Division Cardiovascular And Respiratory Medicine Kobe University Graduate School Of Medicine
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Kiuchi Kunihiko
Department Of Internal Medicine Division Of Cardiovascular Medicine Kobe University Graduate School
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Kiuchi Kunihiko
Division Of Cardiology Sanda City Hospital
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Takano Takatsugu
Department Of Internal Medicine Division Of Cardiovascular Medicine Kobe University Graduate School
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Fukuzawa Kouji
Division Of Cardiovascular And Respiratory Medicine Department Of Internal Medicine Kobe University
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Hirata Kenichi
Division Of Cardiovascularmedicine Kobe University Graduate School Of Medicine
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Yoshida Akihiko
Department Of Internal Medicine Division Of Cardiovascular Medicine Kobe University Graduate School
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Fukuzawa Koji
Division Of Cardiovascular Medicine Department Of Internal Medicine Kobe University Graduate School
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