Results obtained by the modern automatic blood pressure (BP) monitors using oscillometric method [5] are highly dependent on conditions of cardiovascular system of the monitored person. Especially, with people who suffer from cardiovascular diseases (e.g. atherosclerosis) the resulting values differ significantly from those measured by the traditional auscultation method. A reasonable solution for improvement of quality of oscillometric method could be a sophisticated intelligent BP measuring system which applies for evaluation of BP more complex approach taking into account the monitored person's condition of patient cardiovascular system (CS) i.e. the hemodynamic parameters of CS (e.g. heart rate, stroke volume, total peripheral resistance, systemic arterial compliance, pulse wave velocity, augmentation index etc.). Such a system has to be based on appropriate models of the considered diseases which are validated on real life data. For that purpose, we have started to build a database of real-life oscillometric pulsations waveforms (OPW) complemented by the values of "auscultation" blood pressure measurements and additional relevant information about the considered patients (age, sex, etc.) as well as their diagnosis. This data collection requires a special HW device for measurement of the OPW--we have developed such a device and it has been validated in Czech Certified Metrological Centre. Our OPW monitor is connected through the T-pieces and tubes to the cuff, mercury sphygmomanometer and automatic "oscillometric" blood pressure monitor.

• MeSH
• Blood Pressure Monitoring, Ambulatory methods   instrumentation   MeSH
• Databases, Factual MeSH
• Financing, Organized MeSH
• Hemodynamics MeSH
• Cardiovascular Diseases physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Blood Pressure Monitors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female Athlete Triad Syndrome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Publication type
• Comparative Study MeSH

Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60 to 70 times a minute at rest), it pumps out blood into the arteries with different value of systolic pressure SP (highest blood pressure when the heart beats) and different value of diastolic pressure DP (lowest blood pressure when the heart relaxes) [3]. Values of SP and DP change during the whole day with dependence on person’s physical and psychical activity. Accuracy of measurement with the modern automatic blood pressure (BP) monitors using oscillometric method is highly depended on condition of cardiovascular system of the monitored person [1]. Especially, with people who suffer from cardiovascular diseases (e.g. arteriosclerosis) the resulting accuracy is much lower when compared to auscultation method. A reasonable solution for improvement of quality of oscillometric method could be an intelligent universal measuring system for evaluation of BP taking into account condition of patient cardiovascular system (CS) of monitored person i.e. the hemodynamics parameters of CS (e.g. heart rate, stroke volume, total peripheral resistance, systemic arterial compliance). Such a system has to be based on an appropriate model of the considered diseases. To create the models, it is very important to establish a database of oscillometric pulsations waveforms (OPW) complemented by the values of “auscultation” blood pressure and information about patients (age, sex, etc.) as well as their diagnosis. This requires a special HW device for measurement of the OPW – we have developed such a device and it has been validated in Czech Certified Metrological Centre, its accuracy is ± 0.5 mmHg in the measuring range 0 to 300 mmHg. We have introduced the concept of oscillometric pulsations waveform (OPW) database that allows testing of oscillometric algorithms for healthy people and mainly for people whose cardiovascular system is not in standard state (arteriosclerosis etc.). The concept is based on oscillometric data retrieving during cuff deflation and on reference BP measurements by auscultation as in [2]. Together with the data, oscillometric pulsations and cuff pressure are saved into the database. For records of OPW we have developed a special HW device that consists of an arm cuff, a pressure sensor, two regulation valves, batteries and electronic circuits. The device can be controlled from PC by a special SW. The connection with the PC is via USB port. The microcontroller controls the pneumatic and the electronic circuits. Cuff pressure is converted into analog voltage by pressure sensor (Piezoresistive Bridge). The analog voltage is amplified by an amplifier TLV2422 and the amplified cuff pressure signal is then separated into 2 channels by a hi-pass filter. Channel 1 is cuff pressure signal (0-300 mm Hg) and channel 2 represents amplified and filtered cuff pulsations (OPW). The 2 signals are digitized by a 12-bit A/D converter in microcontroller ADuC814 with sampling frequency of 200 Hz. The deflation of the cuff is controlled by the regulations valves. The microcontroller communicates with the notebook computer via FTDI chip. Our OPW monitor is connected through the T-pieces and tubes to the cuff, mercury sphygmomanometer and automatic oscillometric blood pressure monitor. Auscultation values are measured by educated staff. Cuff inflation is controlled by microcontroller of the monitor. Then we can directly compare oscillometric and reference (auscultation) method. Moreover, we exactly know the OPW. Nowadays, we have already collected 950 OPW records of 250 people. There are mainly people older than 60 years in the group and we have tried several algorithms (designed in MATLAB ver. 7.00) for evaluation of systolic and diastolic BP [3] and others hemodynamics parameters of the cardiovascular system (mean arterial pressure, heart rate etc.). We have compared values of BP measured by mercury sphygmomanometer and the commercial oscillometric monitor and we have got less than 80% of the measurements results in range of ± 5 mmHg for systolic and diastolic pressure. In more than 20% for both pressures the differences between oscillometric and reference method were greater than ± 5 mmHg. Difference more than -5 mmHg as well as + 5 mmHg was distributed approximately similar. This is a strong motivation for the creation of our database. We have begun apply on measured values some methods of artificial intelligence (AI), especially data mining with system WEKA [5]. We used correlation and searched some association rules. We validated results of standard statistical analysis but we did not find any other strong rules in the data. Nowadays we plan apply these statistical and AI methods directly on measured oscillometric pulsations. This pilot project could be very useful for development of new blood pressure measurement (BPM) methods and also for determination of correct BPM for each group of cardiovascular condition of patients what can be considerable improvement in medical care and patient satisfaction.

• Publication type
• Abstracts MeSH

OBJECTIVES: This study compared Doppler and oscillometric (PetMAP+) devices (with or without proprietary optimisations) for the non-invasive measurement of blood pressure in conscious cats. METHODS: Twenty-three cats were enrolled; however, five were excluded as fewer than five measurements were obtained for each assessment. All measurements were obtained according to American College of Veterinary Internal Medicine consensus guidelines. Oscillometric device modes A and B were operated according to the manufacturer's guidelines. Doppler and oscillometric devices were used alternately as the first device. RESULTS: Systolic arterial blood pressure (SAP) measurements were obtained by Doppler (SAPd) and oscillometry; the mean of each set of five values was used for statistical analysis. There was a significant difference between SAPd and SAP measurements in oscillometric modes A (P <0.001) and B (P <0.001). While both modes measured SAP higher than SAPd, B had a smaller bias (+15.72 mmHg) and narrower limits of agreement (LOA). There was also a significant difference between SAPd and mean arterial pressure (MAP) on oscillometric modes A (P = 0.002) and B (P <0.001). Both modes' MAP readings were lower than SAPd and oscillometric A MAP was closer to SAPd (-14.94 mmHg), with a smaller bias and narrower LOA. CONCLUSIONS AND RELEVANCE: The findings support that Doppler and oscillometric devices cannot be used interchangeably, with or without proprietary optimisations. Methodology should always be taken into account and reference intervals (RIs) need to be defined for the different methodologies. Until methodology-specific RIs are published, definitive diagnosis of hypertension and sub-staging of patients with kidney disease according to the International Renal Interest Society guidelines remains challenging.

• MeSH
• Cats MeSH
• Blood Pressure MeSH
• Blood Pressure Determination * veterinary   MeSH
• Blood Pressure Monitors MeSH
• Oscillometry veterinary   MeSH
• Ultrasonography, Doppler veterinary   MeSH
• Ultrasonics * MeSH
• Animals MeSH
• Check Tag
• Cats MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Before arterial cannulation for invasive blood pressure monitoring, clinical decision-making depends on non-invasive blood pressure in critically ill patients. Whether non-invasive blood pressure is comparable to invasive measurement is not clearly elucidated. We address this issue as it relates to the use of norepinephrine in patients with cardiogenic shock. METHODS: We analysed invasive and non-invasive blood pressure in 85 patients admitted to the Coronary-Care Unit for cardiogenic shock. We compared initial blood pressure measurement (just after radial artery cannulation) and blood pressure taken during the first 72 hours after admission. Invasive blood pressure was used as the reference method. RESULTS: Initial invasive mean and systolic arterial pressures were in a good agreement with oscillometric blood pressure; mean differences were -0.4 ± 8.8 and +6.1 ± 14.4 mmHg with correlation coefficients of 0.76 and 0.74. Doses of norepinephrine were significant negative determinants of invasive/oscillometric blood pressure differences. The invasive/oscillometric mean arterial pressures and SBP differences were +0.1 ± 3.4 and 7.6 ± 1.6 mmHg in patients treated with nothing or a maximum norepinephrine dose of 0.6 µg/kg/min. However, treatment with very high doses of norepinephrine was associated with a steep rise in mean arterial pressures and SBP invasive/oscillometric differences (-9.5 ± 3.3 and -8.5 ± 5.2 mmHg). In a total of 967 sets of blood pressure measurements, invasive/oscillometric differences were relatively stable across blood pressure categories, with the exception of measurements assessed after very high norepinephrine doses. CONCLUSIONS: Non-invasive BP is a sufficient substitute for invasive measurement in cardiogenic shock patients, with the exception of those receiving very high doses of norepinephrine.

• MeSH
• Arterial Pressure MeSH
• Shock, Cardiogenic physiopathology   MeSH
• Catheterization MeSH
• Blood Pressure drug effects   MeSH
• Critical Illness MeSH
• Middle Aged MeSH
• Humans MeSH
• Blood Pressure Determination methods   MeSH
• Monitoring, Physiologic MeSH
• Norepinephrine administration & dosage   pharmacology   MeSH
• Oscillometry methods   MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Vasoconstrictor Agents administration & dosage   pharmacology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

Cíl studie: Cílem této fyziologické studie bylo sledovat změny srdečního výdeje a další hemodynamické parametry v pro nační poloze a srovnat vliv podložení hrudníku a pánve na hemodynamické parametry. Typ studie: Prospektivní, observační studie. Typ pracoviště: Experimentální laboratoř fakultní nemocnice. Materiál a metoda: Do studie bylo zařazeno 12 zdravých dobrovolníků starších 18 let. V supinní poloze (poloha S) bylo zahájeno neinvazivní hemodynamické monitorování systémem ClearSight/EV 1000. Po stabilizaci byly zaznamenány: srdeční index (CI), index tepového objemu (SVI), variabilita tepového objemu (SVV), index systémové vaskulární rezis tance (SVRI). Dále byly v definovaných místech sonograficky sledovány: exspirační plocha v. cephalica (sVCe), v. saphena (sVSe), v. jugularis interna (sVJe), exspirační a inspirační plocha (sVCIe a sVCIi) a maximální a minimální předozadní průměr (dVCImax a dVCImin) v. cava inferior a kalkulován index kolapsibility (VCI CI). Sonograficky byl stanoven corrected carotid flow time (ccFT). Měření byla opakována v nepodložené (poloha P1) a podložené pronační poloze s podporou proximální části hrudníku a pánve (poloha P2). Výsledky: Mezi jednotlivými polohami nebyly zjištěny rozdíly v hodnotách CI, SVI, SVV a ccFT. Mezi polohami byly zjištěny signifikantní rozdíly v hodnotách MAP a VCI CI. Ve srovnání s polohou S byla v poloze P1 pozorována vyšší hodnota SVRI a vyšší hodnota sVJe. Nižší hodnota dVCImin byla zaznamenána v poloze P2 ve srovnání s polohou P1. Závěr: U zdravých nesedovaných dobrovolníků nebyl v pronační poloze pozorován pokles srdečního výdeje ani preloadu, ale byly zjištěny změny systémové vaskulární rezistance a stagnace krve v jugulárním řečišti. V nepodložené pronační poloze byla zjištěna zvýšená kolapsibilita dolní duté žíly.

Background and Goal of the study: The aim of this physiological study was to observe changes in cardiac output and other hemodynamic parameters after proning and to compare hemodynamic profile of prone position with and without chest and pelvic support. Type of study: Prospective, observational study. Setting: Clinical laboratory of a university hospital. Material and Methods: Twelve healthy volunteers older than 18 years were included in the study. Non-invasive hemody namic measurement was initiated using ClearSight/EV 1000 system in supine position (S position). Cardiac index (CI), stroke volume index (SVI), stroke volume variation (SVV), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) were recorded. Following parameters were measured using ultrasound at predefined sites: expiratory area of v. cephalica (sVCe), v. saphena (sVSe), v. jugularis interna (sVJe), expiratory and inspiratory area (sVCIe a sVCIi), and maximum and minimum diameter (dVCImax a dVCImin) of v. cava inferior and index of colapsibility (VCI CI) were calculated. Corrected carotid flow time (ccFT) was measured using a Doppler ultrasound. All measurements were repeated in unsupported (P1 position) and supported (P2 position) prone positions with supported chest and pelvic regions. Results and Discussion: There were no differences in CI, SVI, SVV and ccFT values between positions. Significantly different values of MAP and VCI CI were observed between positions. Higher SVRI in P1 position in comparison with S position, higher sVJe in prone positions and lower dVCImin in P2 position in comparison with P1 position were recorded. Conclusion: No differences in cardiac output and preload were detected after proning in unsedated healthy volunteers. Prone position was associated with changes of systemic vascular resistance, blood stagnation in jugular catchment area and, in unsupported prone position, increased collapsibility of inferior vena cava.

• MeSH
• Hemodynamic Monitoring * MeSH
• Hemodynamics MeSH
• Humans MeSH
• Observational Studies as Topic MeSH
• Prone Position * MeSH
• Prospective Studies MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: The use of goal directed fluid protocols in intermediate risk patients undergoing hip or knee replacement was studied in few trials using invasive monitoring. For this reason we have implemented two different fluid management protocols, both based on a novel totally non-invasive arterial pressure monitoring device and compared them to the standard (no-protocol) treatment applied before the transition in our academic institution. METHODS: Three treatment groups were compared in this prospective study: the observational (CONTROL, N = 40) group before adoption of fluid protocols and two randomized groups after the transition to protocol fluid management with the use of the continuous non-invasive blood pressure monitoring (CNAP®) device. In the PRESSURE group (N = 40) standard variables were used for restrictive fluid therapy. Goal directed fluid therapy using pulse pressure variation was used in the GDFT arm (N = 40). The influence on the rate of postoperative complications, on the hospital length of stay and other parameters was assessed. RESULTS: Both protocols were associated with decreased fluid administration and maintained hemodynamic stability. Reduced rate of postoperative infection and organ complications (22 (55 %) vs. 33 (83 %) patients; p = 0.016; relative risk 0.67 (0.49-0.91)) was observed in the GDFT group compared to CONTROL. Lower number of patients receiving transfusion (4 (10 %) in GDFT vs. 17 (43 %) in CONTROL; p = 0.005) might contribute to this observation. No significant differences were observed in other end-points. CONCLUSION: In our study, the use of the fluid protocol based on pulse pressure variation assessed using continuous non-invasive arterial pressure measurement seems to be associated with a reduction in postoperative complications and transfusion needs as compared to standard no-protocol treatment. TRIAL REGISTRATION: ACTRN12612001014842.

• MeSH
• Arterial Pressure physiology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Arthroplasty, Replacement, Hip adverse effects   methods   MeSH
• Monitoring, Intraoperative adverse effects   methods   MeSH
• Postoperative Complications diagnosis   etiology   prevention & control   MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Fluid Therapy methods   MeSH
• Arthroplasty, Replacement, Knee adverse effects   methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

BACKGROUND: Stage 1 hypertension influences acute cardiovascular responses to resistance exercises and post-exercise recovery. We examined whether the order of exercises, particularly in agonist-antagonist pairings, can alter these cardiovascular responses. This study compares systolic and diastolic blood pressure responses during agonist and agonist-antagonist paired sets of upper and lower-body resistance exercises with a load of 75% repetition maximum in individuals with normotension and stage 1 hypertension. METHODS: A cross-sectional study enrolled 47 participants with sedentary jobs, comprising 30 normotensive individuals (47.8 ± 5.9 years, height 174.8 ± 10.2 cm, weight 77.7 ± 15.4 kg, BMI 25.3 ± 3.6 kg/m2) and 17 hypertensive individuals (54.3 ± 6.0 years, 177.6 ± 11.3 cm, 89.8 ± 16.4 kg, BMI 28.5 ± 4,5 kg/m2). Acute cardiovascular parameters were measured using an arteriograph, a non-invasive device designed to assess vascular stiffness and cardiovascular health, after each set of resistance training. RESULTS: No significant differences in systolic blood pressure changes were found between the resistance training methods and aerobic exercise when comparing normotensive and hypertensive individuals. However, significant increases in systolic blood pressure were observed during lower-body exercises (11.3-24.7 mmHg for normotensives and 11.7-24.1 mmHg for hypertensives, p < 0.05). Hypertensive individuals showed slightly higher increases during lower-body supersets (p < 0.05). Regarding diastolic blood pressure, significant decreases were noted during upper-body resistance training for both groups, especially for normotensives (-10.6 to -13.7 mmHg, p < 0.05). CONCLUSIONS: Agonist and agonist-antagonist paired set resistance training for both lower and upper-body exercises resulted in similar blood pressure changes in individuals with normotension and stage 1 hypertension. These findings suggest that both methods may have comparable cardiovascular effects across blood pressure. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT06047678). Registration date: 31 August 2023.

• Publication type
• Journal Article MeSH

Úvod: Stanovení transkutánní tenze kyslíku (TcpO2) je neinvazivní metodou pro testování periferního kožního prokrvení na kapilární úrovni a jejich nutriční schopnost potřebnou ke zhojení ischemického defektu. Hodnoty TcpO2 pod 30 mmHg jsou specifické pro kritickou končetinovou ischemii a predikují obtížné hojení defektu. Cílem této práce bylo ověření cut-off hodnoty potřebné ke zhojení defektu u pacientů bez možnosti provedení cévně-rekonstrukční intervence a ověření možnosti použití této metody ke zhodnocení efektivity provedeného cévně-rekonstrukčního výkonu. Metody: Do souboru bylo zařazeno celkem 52 pacientů (35 mužů a 17 žen). Průměrný věk pacientů v souboru byl 66,5 roku (max. 85, min. 44). Výsledky: V našem souboru pacientů jsme potvrdili, že ve skupině úspěšně zhojených ischemických ran byla hodnota TcpO2 rovna nebo vyšší než 30 mmHg (průměrná hodnota TcpO2 na nártu byla 37,0 mmHg ?9,5 mmHg), oproti skupině nezhojených pacientů, kde byly hodnoty nižší (průměrná hodnota TcpO2 na nártu byla 9,0 mmHg ?5,3 mmHg ). Závěr: TcpO2 je tedy vhodnou metodou při predikci hojení ischemického defektu a případné potřeby angiochirurgické nebo endovaskulární revaskularizace. Díky své neinvazivitě a nenáročnosti měření jistě pomáhá lépe rozhodovat ve volbě terapeutického postupu potřebného ke zhojení defektu. Kličová slova: transkutánní tenze kyslíku − cut-off hodnota − revaskularizace

Introduction: The measurement of transcutaneous oxygen pressure (TcpO2) is a non-invasive method to quantify skin oxygenation at capillary level and their nutritive ability needed to heal the ischemic defect. TcpO2 pressure values below 30 mm Hg are specific for critical limb ischemia and predict complicated healing. The purpose of this study was to verify the cut-off pressure in patient unable to undergo vascular reconstruction, and to verify the possibility of using this method to evaluate the effectiveness of vascular reconstructive surgery. Methods: The group included 52 patients (35 men and 17 women). The mean age of patients in the group was 66.5 years (max. 85, min. 44). Results: In our group of patients we confirmed that the TcpO2 values of successfully healed ischemic wounds were equal or greater than 30 mm Hg (mean TcpO2 value at the dorsum of the foot was 37.0 mm Hg ?9.5 mm Hg), compared to the group of unsuccessfully healed patients whose values were lower (mean TcpO2 value at the dorsum of the foot was 9.0 mm Hg ?5.3 mm Hg). Conclusion: TcpO2 is a suitable method in predicting the healing of ischemic defects and any possible need for surgical or endovascular revascularization. Thanks to its non-invasive nature and undemanding measurement, it surely helps to make better decisions in choosing the therapeutic procedure needed to heal the defect.

• MeSH
• Amputation, Surgical MeSH
• Chronic Disease MeSH
• Lower Extremity * blood supply   MeSH
• Wound Healing MeSH
• Ischemia * complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Blood Gas Monitoring, Transcutaneous * utilization   MeSH
• Vascular Surgical Procedures MeSH
• Treatment Outcome MeSH
• Plastic Surgery Procedures MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH

Epilepsy, affecting over 50 million people globally, presents a significant neurological challenge. Effective prevention of epileptic seizures relies on proper administration and monitoring of Anti-Seizure Medication (ASMs). Therapeutic Drug Monitoring (TDM) ensures optimal dosage adjustment, minimizing adverse effects and potential drug interactions. While traditional venous blood collection for TDM may be stressful, emerging alternative sampling methods, particularly Dried Blood Spot (DBS) or oral fluid offer less invasive way of sampling. This study aimed to develop and validate an analytical method for the determination of lamotrigine in such alternative samples. The sample, either DBS or oral fluid, was subjected to extraction, evaporation, and reconstitution in 15 % acetonitrile containing 0.1 % formic acid. A Kinetex C18 Polar column was used for liquid chromatographic separation and MS in ESI+ mode was used for detection and quantitation of lamotrigine using an isotopically labelled internal standard according to EMA guidelines. The calibration range of the developed method enables the determination of lamotrigine in the concentration range of 1-30 μg/mL in DBS and 0.5-20 μg/mL in oral fluid. Oral fluid and DBS samples from patients treated with lamotrigine analysed by the developed method were compared to plasma concentrations measured by the hospital's accredited laboratory. Preliminary results indicate a promising potential for these alternative matrices in clinical TDM applications. By offering a less invasive sampling approach, this method improves the accessibility and safety of pharmacotherapy for epilepsy patients. The results of this study lay the foundation for further clinical applications by implementing alternative matrix TDM, which may significantly advance personalized care in epilepsy management.

• MeSH
• Anticonvulsants * analysis   blood   MeSH
• Chromatography, Liquid methods   MeSH
• Epilepsy drug therapy   MeSH
• Calibration MeSH
• Liquid Chromatography-Mass Spectrometry MeSH
• Lamotrigine * analysis   blood   MeSH
• Humans MeSH
• Limit of Detection MeSH
• Drug Monitoring * methods   MeSH
• Reproducibility of Results MeSH
• Saliva * chemistry   MeSH
• Tandem Mass Spectrometry methods   MeSH
• Dried Blood Spot Testing * methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Validation Study MeSH

AIMS: Right ventricular apical pacing has a detrimental effect on left ventricular (LV) function. More optimal pacing site may be found by invasive measurement of LV mechanical performance during pacing from different RV pacing sites. We aimed to investigate the effect of RV pacing lead location on invasive indices of LV mechanical performance. METHODS AND RESULTS: Patients undergoing catheter ablation for persistent atrial fibrillation were enrolled. Single-site endocardial pacing from the lateral LV region was periodically switched to pacing from the mapping catheter navigated to different RV sites within the three-dimensional electroanatomical RV map. SystIndex, DiastIndex, and PPIndex were defined as the ratio of LV dP/dtmax, LV dP/dtmin, and arterial pulse pressure during RV pacing to corresponding values from adjacent periods of LV pacing. Haemodynamic data were analysed in 18 RV segments created by dividing RV horizontally (basal, mid, and apical portion), vertically (inferior, mid, and superior portion) and frontally (septum and free wall). Eight patients (58 ± 7 years; 2 females; 26 ± 4 RV pacing sites per patient) were enrolled into the study. Compared with LV pacing, the best RV pacing values of SystIndex and DiastIndex were achieved in basal-mid-septal segment (+6.9%, P = 0.02 and +3.4%, P = 0.36, respectively) while the best PPIndex was obtained in superior-mid-septal segment of RV (+4.5%, P = 0.02). All indices were fairly concordant showing significant improvement of haemodynamics during RV pacing in the direction from free wall to septum, from apex to base, and from inferior to superior segments. CONCLUSION: The best LV mechanical performance was achieved by RV septal pacing in the non-apical mid-to-superior segments.

• MeSH
• Time Factors MeSH
• Diastole * MeSH
• Electrophysiologic Techniques, Cardiac MeSH
• Electrocardiography MeSH
• Atrial Fibrillation diagnosis   physiopathology   surgery   MeSH
• Ventricular Function, Left * MeSH
• Ventricular Function, Right * MeSH
• Cardiac Pacing, Artificial methods   MeSH
• Catheter Ablation MeSH
• Blood Pressure MeSH
• Middle Aged MeSH
• Humans MeSH
• Ventricular Septum physiopathology   MeSH
• Predictive Value of Tests MeSH
• Heart Ventricles physiopathology   MeSH
• Systole * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH