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Echo-driven V-V optimization determines clinical improvement in non responders to cardiac resynchronization treatment.

Naqvi TZ, Rafique AM, Peter CT - Cardiovasc Ultrasound (2006)

Bottom Line: In patients who derive sup-optimal benefit from biventricular pacing, optimization of atrioventricular delay post cardiac resynchronization treatment has been shown to improve cardiac output.In this report we describe the beneficial effect of sequential V-V pacing on inter and intraventricular synchrony, cardiac output and mitral regurgitation severity as the mechanisms whereby sequential biventricular pacing improves cardiac output and functional class in 8 patients who had derived no benefit or had deteriorated after CRT.Online tissue Doppler imaging including tissue velocity imaging, tissue synchronization imaging and strain and strain rate imaging were used in addition to conventional pulsed wave and color Doppler during sequential biventricular pacemaker programming.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiac Non-Invasive Laboratory, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. tasneem.naqvi@cshs.org

ABSTRACT
Echocardiography plays an integral role in the detection of mechanical dyssynchrony in patients with congestive heart failure and in predicting beneficial response to cardiac resynchronization treatment. In patients who derive sup-optimal benefit from biventricular pacing, optimization of atrioventricular delay post cardiac resynchronization treatment has been shown to improve cardiac output. Some recent reports suggest that sequential ventricular pacing may further improve cardiac output. The mechanism whereby sequential ventricular pacing improves cardiac output is likely improved inter and possibly intraventricular synchrony, however these speculations have not been confirmed. In this report we describe the beneficial effect of sequential V-V pacing on inter and intraventricular synchrony, cardiac output and mitral regurgitation severity as the mechanisms whereby sequential biventricular pacing improves cardiac output and functional class in 8 patients who had derived no benefit or had deteriorated after CRT. Online tissue Doppler imaging including tissue velocity imaging, tissue synchronization imaging and strain and strain rate imaging were used in addition to conventional pulsed wave and color Doppler during sequential biventricular pacemaker programming.

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Left ventricular outflow tract pulsed wave Doppler velocity at LV pre-excitation of 5 ms (A) and LV pre-excitation of 10 ms (B). An increase in LV ejection time is shown in panel B. Also note the narrowing of QRS complex in panel B compared to panel A (white arrow heads).
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Figure 5: Left ventricular outflow tract pulsed wave Doppler velocity at LV pre-excitation of 5 ms (A) and LV pre-excitation of 10 ms (B). An increase in LV ejection time is shown in panel B. Also note the narrowing of QRS complex in panel B compared to panel A (white arrow heads).

Mentions: A 67-year-old Caucasian male underwent aortic valve replacement with a bioprosthetic valve, mitral valve annuloplasty and epicardial LV pacing for CHF, complete heart block, LVEF of 12%, NYHA class III symptoms and BNP of 1442 pg/ml. NYHA improved to class II, 2 months later and he was referred for biv pacemaker optimization. LVEF was 38%, there was a normally functioning bioprosthetic aortic valve, a mitral annuloplasty ring with trivial MR and pulmonary artery pressure was 35 mmHg. There was in sinus rhythm and the baseline pacemaker settings were A-sensed AV delay of 180 ms and LV pre excitation of 5 ms with biv pacing. Optimal AV delay by iterative method was 180 ms. LV pre excitation of 10 ms abolished the marked delay seen on TSI in the entire lateral and posterior as well as in the basal inferior wall (Figure 4). There was concomitant improvement in LV ejection duration (Figure 5). At the paced atrial rate of 80 beats per minute, best LV diastolic filling appeared to be present at 140 ms AV delay. Rate response features were used so that at a heart rate above 100 beats per minute, the AV delay would decrease to 120 ms. Final pacemaker settings were sensed AV delay of 180 ms and LV pre-excitation of 10 ms.


Echo-driven V-V optimization determines clinical improvement in non responders to cardiac resynchronization treatment.

Naqvi TZ, Rafique AM, Peter CT - Cardiovasc Ultrasound (2006)

Left ventricular outflow tract pulsed wave Doppler velocity at LV pre-excitation of 5 ms (A) and LV pre-excitation of 10 ms (B). An increase in LV ejection time is shown in panel B. Also note the narrowing of QRS complex in panel B compared to panel A (white arrow heads).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1636667&req=5

Figure 5: Left ventricular outflow tract pulsed wave Doppler velocity at LV pre-excitation of 5 ms (A) and LV pre-excitation of 10 ms (B). An increase in LV ejection time is shown in panel B. Also note the narrowing of QRS complex in panel B compared to panel A (white arrow heads).
Mentions: A 67-year-old Caucasian male underwent aortic valve replacement with a bioprosthetic valve, mitral valve annuloplasty and epicardial LV pacing for CHF, complete heart block, LVEF of 12%, NYHA class III symptoms and BNP of 1442 pg/ml. NYHA improved to class II, 2 months later and he was referred for biv pacemaker optimization. LVEF was 38%, there was a normally functioning bioprosthetic aortic valve, a mitral annuloplasty ring with trivial MR and pulmonary artery pressure was 35 mmHg. There was in sinus rhythm and the baseline pacemaker settings were A-sensed AV delay of 180 ms and LV pre excitation of 5 ms with biv pacing. Optimal AV delay by iterative method was 180 ms. LV pre excitation of 10 ms abolished the marked delay seen on TSI in the entire lateral and posterior as well as in the basal inferior wall (Figure 4). There was concomitant improvement in LV ejection duration (Figure 5). At the paced atrial rate of 80 beats per minute, best LV diastolic filling appeared to be present at 140 ms AV delay. Rate response features were used so that at a heart rate above 100 beats per minute, the AV delay would decrease to 120 ms. Final pacemaker settings were sensed AV delay of 180 ms and LV pre-excitation of 10 ms.

Bottom Line: In patients who derive sup-optimal benefit from biventricular pacing, optimization of atrioventricular delay post cardiac resynchronization treatment has been shown to improve cardiac output.In this report we describe the beneficial effect of sequential V-V pacing on inter and intraventricular synchrony, cardiac output and mitral regurgitation severity as the mechanisms whereby sequential biventricular pacing improves cardiac output and functional class in 8 patients who had derived no benefit or had deteriorated after CRT.Online tissue Doppler imaging including tissue velocity imaging, tissue synchronization imaging and strain and strain rate imaging were used in addition to conventional pulsed wave and color Doppler during sequential biventricular pacemaker programming.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiac Non-Invasive Laboratory, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. tasneem.naqvi@cshs.org

ABSTRACT
Echocardiography plays an integral role in the detection of mechanical dyssynchrony in patients with congestive heart failure and in predicting beneficial response to cardiac resynchronization treatment. In patients who derive sup-optimal benefit from biventricular pacing, optimization of atrioventricular delay post cardiac resynchronization treatment has been shown to improve cardiac output. Some recent reports suggest that sequential ventricular pacing may further improve cardiac output. The mechanism whereby sequential ventricular pacing improves cardiac output is likely improved inter and possibly intraventricular synchrony, however these speculations have not been confirmed. In this report we describe the beneficial effect of sequential V-V pacing on inter and intraventricular synchrony, cardiac output and mitral regurgitation severity as the mechanisms whereby sequential biventricular pacing improves cardiac output and functional class in 8 patients who had derived no benefit or had deteriorated after CRT. Online tissue Doppler imaging including tissue velocity imaging, tissue synchronization imaging and strain and strain rate imaging were used in addition to conventional pulsed wave and color Doppler during sequential biventricular pacemaker programming.

Show MeSH
Related in: MedlinePlus