JACC. Case reports · 2025
Pressure-Volume Loop Optimization of Cardiac Resynchronization Therapy in a Left Ventricular Assist Device Patient.
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Inglis Sara S, Rosenbaum Andrew N, Wong Martin, Rahme Serena J, Schettle Sarah D, Chaikijurajai Thanat, daSilva-deAbreu Adrian J, Killu Ammar M, Sugrue Alan M, Behfar Atta
Аннотация
BACKGROUND: Patients with a left ventricular assist device (LVAD) often have a pre-existing cardiac resynchronization therapy (CRT) device, although guidelines highlight uncertainty surrounding postimplant programming.
CASE SUMMARY: A 60-year-old man with a HeartMate 3 (Abbott) had left bundle branch-optimized CRT. Right/left heart catheterization with biventricular pressure-volume (PV) loops was performed for device optimization.
WHY BEYOND THE GUIDELINES: Guidelines suggest that both leaving CRT on (remodeling benefit) or turning off (improve battery) may be appropriate for patients with LVAD. PV loops may serve as a powerful tool for guiding individualized device optimization.
DISCUSSION: Optimal pacing was determined based on greatest benefit in biventricular contractility and volume reduction. The results highlight the complexity of biventricular interaction in CRT, particularly in an LVAD patient.
TAKE-HOME MESSAGE: Biventricular PV loops provide unique insight to individualize optimization of native ventricular function in continuous flow device-based support.
CASE SUMMARY: A 60-year-old man with a HeartMate 3 (Abbott) had left bundle branch-optimized CRT. Right/left heart catheterization with biventricular pressure-volume (PV) loops was performed for device optimization.
WHY BEYOND THE GUIDELINES: Guidelines suggest that both leaving CRT on (remodeling benefit) or turning off (improve battery) may be appropriate for patients with LVAD. PV loops may serve as a powerful tool for guiding individualized device optimization.
DISCUSSION: Optimal pacing was determined based on greatest benefit in biventricular contractility and volume reduction. The results highlight the complexity of biventricular interaction in CRT, particularly in an LVAD patient.
TAKE-HOME MESSAGE: Biventricular PV loops provide unique insight to individualize optimization of native ventricular function in continuous flow device-based support.