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Ventricular force‐frequency relationships during biventricular or multisite pacing in congenital heart disease

Shankar Baskar, Andrew N. Redington, Philip R. Khoury, Timothy K. Knilans, David S. Spar, Richard J. Czosek

The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

* Corresponding Author: Shankar Baskar, MD, The Heart Institute, Cincinnati Children’s Hospital Medical Center, MLC: 2003, Cincinnati, OH 45229, USA. Email: email

Congenital Heart Disease 2019, 14(2), 201-206. https://doi.org/10.1111/chd.12684

Abstract

Background: Traditional indices to evaluate biventricular (BiV) pacing are load dependent, fail to assess dynamic changes, and may not be appropriate in patients with congenital heart disease (CHD). We therefore measured the force‐frequency relationship (FFR) using tissue Doppler‐de‐ rived isovolumic acceleration (IVA) to assess the dynamic adaption of the myocardium and its vari‐ ability with different ventricular pacing strategies.
Methods: This was a prospective pilot study of pediatric and young adult CHD patients with biventricular or multisite pacing systems. Color‐coded myocardial velocities were recorded at the base of the systemic ventricular free wall. IVA was calculated at resting heart rate and with incremental pacing. FFR curves were obtained by plotting IVA against heart rate for different ventricular pacing strategies.
Results: Ten patients were included (mean: 22 ± 7 years). The FFR identified a best and worst ventricular pacing strategy for each patient, based on the AUC at baseline, submaximal, and peak heart rates (P < .001). However, there was no single best ventricular pacing strategy that was optimal for all patients. Additionally, the best ventricular pacing strategy often differed within the same patient at different heart rates.
Conclusion: This novel assessment demonstrates a wide variability in optimal ventricular pac‐ ing strategy. These inherent differences may play a role in the unpredictable clinical response to BiV pacing in CHD, and emphasizes an individualized approach. Furthermore, the optimal ventricular pacing varies with heart rate within individuals, suggesting that rate‐responsive ventricular pacing modulation may be required to optimize ventricular performance.

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APA Style
Baskar, S., Redington, A.N., Khoury, P.R., Knilans, T.K., Spar, D.S. et al. (2019). Ventricular force‐frequency relationships during biventricular or multisite pacing in congenital heart disease. Congenital Heart Disease, 14(2), 201-206. https://doi.org/10.1111/chd.12684
Vancouver Style
Baskar S, Redington AN, Khoury PR, Knilans TK, Spar DS, Czosek RJ. Ventricular force‐frequency relationships during biventricular or multisite pacing in congenital heart disease. Congeni Heart Dis. 2019;14(2):201-206 https://doi.org/10.1111/chd.12684
IEEE Style
S. Baskar, A.N. Redington, P.R. Khoury, T.K. Knilans, D.S. Spar, and R.J. Czosek "Ventricular force‐frequency relationships during biventricular or multisite pacing in congenital heart disease," Congeni. Heart Dis., vol. 14, no. 2, pp. 201-206. 2019. https://doi.org/10.1111/chd.12684



cc This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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