Changes in the optimal cardiac resynchronization therapy pacing configuration during physiologic stress.

BACKGROUND: Some patients with ongoing heart failure symptoms after treatment with cardiac resynchronization therapy (CRT) demonstrate QRS prolongation during exercise. We investigated whether the optimal CRT pacing configuration changes during dobutamine stress. METHODS: Seven patients undergoing CRT implantation underwent invasive LV dP/dTmax measurement during CRT pacing in 10 configurations to determine the optimal baseline pacing configuration (OPC). Measurements were repeated during dobutamine infusion. Differences in mean LV dP/dTmax between pacing configurations were compared. RESULTS: Baseline OPC differed from stress OPC in 6/7 patients. The mean (SD) LV dP/dTmax obtained during dobutamine infusion was 1140 (377) mmHg/s in AAI pacing, 1458 (448) mmHg/s in the baseline OPC, and 1656 (435) mmHg/s in the dobutamine OPC (p < 0.001 for differences). The mean increase in LV dP/dTmax obtained by changing from baseline OPC to dobutamine OPC during dobutamine infusion was 197 (338) mmHg/s (13%). The QRS duration, QRS morphology, QLV and QRV intervals did not change significantly during dobutamine infusion (all P > 0.05). CONCLUSIONS: The optimal CRT pacing configuration changes during dobutamine infusion while LV and RV activation timing does not. Further studies investigating the usefulness of automated dynamic changes to CRT pacing configuration according to physiologic condition may be warranted.

Duke Scholars

Author William Schuyler Jones Medicine, Cardiology

Author Zak Loring Medicine, Cardiology

Author Daniel Friedman Medicine, Cardiology