Imperial College London

ProfessorDarrelFrancis

Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7594 3381d.francis Website

 
 
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Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{ShunShin:2019:10.1111/jce.14001,
author = {ShunShin, MJ and Miyazawa, AA and Keene, D and Sterliski, M and Sokal, A and Heuverswyn, F and Rinaldi, CA and Cornelussen, R and Stegemann, B and Francis, DP and Whinnett, Z},
doi = {10.1111/jce.14001},
journal = {Journal of Cardiovascular Electrophysiology},
title = {How to deliver personalized Cardiac Resynchronization Therapy through the precise measurement of the acute hemodynamic response: insights from the iSpot trial},
url = {http://dx.doi.org/10.1111/jce.14001},
year = {2019}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - IntroductionNew pacing technologies offer greater choice of left ventricular pacing sites and greater personalization of cardiac resynchronization therapy (CRT). The effects on cardiac function of novel pacing configurations are often compared using multibeat averages of acute hemodynamic measurements. In this analysis of the iSpot trial we explore whether this is sufficient.MethodsThe iSpot trial was an international, prospective, acute hemodynamic trial that assessed seven CRT configurations: Standard CRT, Multispot (posterolateral vein), and Multivein (anterior and posterior vein) pacing. Invasive and noninvasive blood pressure, and LV dP/dtmax were recorded. Eight beats were recorded before and after an alternation from AAI to the tested pacing configuration and viceversa. Eight alternations were performed for each configuration at each of the 5 AV delays.Results25 patients underwent the full protocol of 8 alternations. Only 4 (16%) patients had a statistically significant >3mmHg improvement over conventional CRT configuration (posterolateral vein, distal electrode). However, if only one alternation was analyzed (standard multibeat averaging protocol), 15 (60%) patients falsely appeared to have a superior nonconventional configuration. Responses to pacing were significantly correlated between the different hemodynamic measures: invasive SBP versus noninvasive SBP r=0.82 (p<0.001); invasive SBP versus LV dP/dt r=0.57, r2=0.32 (p<0.001).ConclusionsCurrent standard multibeat acquisition protocols are unfortunately unable to prevent false impressions of optimality arising in individual patients. Personalization processes need to include distinct repeated transitions to the tested pacing configuration in addition to averaging multiple beats. The need is not only during research stages, but also during clinical implementation.
AU - ShunShin,MJ
AU - Miyazawa,AA
AU - Keene,D
AU - Sterliski,M
AU - Sokal,A
AU - Heuverswyn,F
AU - Rinaldi,CA
AU - Cornelussen,R
AU - Stegemann,B
AU - Francis,DP
AU - Whinnett,Z
DO - 10.1111/jce.14001
PY - 2019///
SN - 1045-3873
TI - How to deliver personalized Cardiac Resynchronization Therapy through the precise measurement of the acute hemodynamic response: insights from the iSpot trial
T2 - Journal of Cardiovascular Electrophysiology
UR - http://dx.doi.org/10.1111/jce.14001
UR - http://hdl.handle.net/10044/1/70416
ER -