A minimally-invasive hybrid approach for cardiac resynchronization of the systemic right ventricle.
Pacing Clin Electrophysiol. 2018 Dec 06;:
Authors: Moore JP, Gallotti RG, Shannon KM, Biniwale R
BACKGROUND: Patients with systemic right ventricles (RV) often develop progressive heart failure and may benefit from cardiac resynchronization therapy (CRT), however the optimal strategy for CRT has not been defined.
METHODS: A retrospective review of all patients with systemic RV failure undergoing a hybrid transcatheter-surgical approach was performed. Procedural technique and outcomes are reported.
RESULTS: Six patients underwent detailed EAM of the systemic RV followed by a new hybrid approach targeting latest endocardial activation followed by focused epicardial mapping. The exact site of latest endocardial activation was variable but localized to the basolateral RV in all cases. Sites of latest activation tended to be more superior during contralateral ventricular pacing versus intact AV conduction (p = 0.06). Latest endocardial activation at the targeted site occurred at 157 ms (IQR 120-181 ms) and corresponding epicardial activation 174 ms (IQR 140-198 ms), after the onset of the QRS complex. Following hybrid CRT, the QRS duration decreased from a median of 193 to 147 ms and the FAC increased from a median of 15.5 to 30% (p < 0.001). Patients were discharged to home after a median of 4 days. Of 3 patients initially referred for transplant evaluation, 2 (66%) no longer met criteria following CRT.
CONCLUSIONS: Whereas latest endocardial activation for the systemic RV appears to localize to the basolateral region, the optimal lead position may be variable. An approach utilizing endocardial mapping followed by a limited surgical incision and confirmation of latest activation may result in minimally invasive surgery and a favorable acute CRT response. This article is protected by copyright. All rights reserved.
PMID: 30520520 [PubMed – as supplied by publisher]