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Left Ventricular Pacing Site Important in Heart Failure

Study finds site likely determines hemodynamic response in cardiomyopathy patients

MONDAY, Nov. 23 (HealthDay News) -- In cardiomyopathy patients referred for implantation of a cardiac resynchronization therapy (CRT) device, the left ventricular (LV) pacing site primarily determines the hemodynamic response, according to a study published online Nov. 18 in the Journal of the American College of Cardiology.

Nicolas Derval, M.D., of Hopital Cardiologique du Haut Leveque in Pessac, France, and colleagues systematically assessed the LV quantitative hemodynamic response to pacing at each of 10 transseptally accessed endocardial sites and at the conventional coronary sinus site in 31 patients with non-ischemic dilated cardiomyopathy referred for CRT device implantation.

The researchers found that the hemodynamic response varied greatly within individuals and between individuals. LV dual-chamber pacing at the best pacing site significantly improved the maximum change in LV pressure over time (+dP/dTmax) and was better than pacing the lateral LV wall, the latest activated LV wall and the coronary sinus.

"Derval et al show in 35 patients with non-ischemic dilated cardiomyopathy that not only is the LV pacing site a determinant of the hemodynamic response but that there is a great degree of variability in the most optimal pacing site, even within this relatively homogeneous group of patients," write the authors of an accompanying editorial.

Several authors of the article reported financial and consulting relationships with medical device companies.

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