Naslov
Can the septal flash predict volume responders prior to CRT device implantation? An intraoperative echocardiography study of immediate LV reverse remodelling by selective LV lead placement

Autori
Čikeš, Maja ; Bijnens, B. ; Širić, H. ; Velagić, V. ; Samardžić, Jure ; Gašparović, Hrvoje ; Lovrić-Benčić, Martina ; Ferek-Petrić, Božidar ; Biočina, Bojan ; Miličić, Davor

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Abstracts of the ESC Congress 2010 ; u: European Heart Journal 31 (2010) (S1) / - , 2010

Skup
ESC Congress

Mjesto i datum
Stockholm, Švedska, 2010

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
CRT device; intraoperative echocardiography; reverse remodelling

Sažetak
Background: A 30% rate of non-responders to cardiac resynchronization therapy (CRT) poses a challenge to better define the potential candidates before device implantation. A mechanism based approach to patient selection has been recently proposed, part of which suggests the septal flash as a sign of intraventricular dyssynchrony, predictive of CRT response. We hypothesize that immediate response to CRT implantation can be detected by resolution of the septal flash immediately following device activation, thus demonstrating that the presence of a septal flash prior to CRT pacing is a direct consequence of early septal activation in LBBB, correctable by CRT. Methods: Data from 12 consecutive patents (5F/7M, 55±14 years) referred for surgical CRT implantation via a mini-thoracotomy were analyzed. Intraoperative transoesophageal echocardiography as well as Doppler myocardial imaging data were acquired pre- and post-CRT device activation. The septal flash was defined as an early ventricular inward and outward septal motion within the isovolumic contraction period, imaged using gray-scale or Tissue Doppler color (anatomical) M-mode. Reverse remodeling was defined as a reduction of end-systolic volume (LVESV) ≥10%. The right atrial and ventricular leads were placed transvenously and the LV screw-in lead was positioned epicardially on the lateral wall. Additionally, selective LV lead pacing was performed on 4 sites (basal and apical anterolateral/posterolateral wall) in order to optimize the LV pacing lead position, guided by echocardiographic measurements of the greatest septal flash reduction and increase in dP/dt. Results: The septal flash was detected preoperatively in all patients and resolved immediately after onset of biventricular pacing. Immediately following pacemaker activation, a significant reduction of LVESV (177±90 ml vs.132±75 ml, p=0.0002) and increase in EF (23±9% vs. 33±8%, p=0.00003) were measured in all patients. Likewise, a significant increase of post-implantation dP/dt (measured from the mitral regurgitation trace) was noted in all patients (343.7±61.3 mmHg/s vs. 664.7±202.4 mmHg/s, p=0.001). The most frequently chosen LV pacing site was the basal posterolateral wall (50% of pts). Conclusion: Preoperative presence of the septal flash is a valid predictor of response to CRT. Immediately after CRT device activation, the septal flash disappears and LV reverse remodeling as well as an increase in contractility are observed. Additionally, intraoperative echocardiography is a feasible tool which can be used in the guidance of optimal LV lead placement.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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