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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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PW Doppler showing left ventricular outflow tract velocity. Improvement in left ventricular ejection duration is shown in B during LV pre-excitation of 40 ms compared to baseline VV delay of 0 ms in A.
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Figure 7: PW Doppler showing left ventricular outflow tract velocity. Improvement in left ventricular ejection duration is shown in B during LV pre-excitation of 40 ms compared to baseline VV delay of 0 ms in A.

Mentions: This 67 year old Caucasian male with a history of inferior myocardial infarction and severe MR, underwent CRT and presented with an 8 week history of NYHA class III symptoms 15 months post CRT. Pacemaker was programmed at paced AV delay of 180 ms and VV delay of 0 ms following AV and VV optimization 14 months ago. He had no underlying AV conduction. There was moderate MR, LVEF was 37% and peak PAP was 40 mm Hg. There were essentially no mitral inflow A waves between an AV delay of 50 to 120 msec and marked atrial truncation was seen at an AVD of 180 ms. Progressive improvement in mitral and pulmonary vein inflow occurred with progressively increasing AV delay to 210 ms. Delay seen in the lateral, septal, inferior and posterior walls and right ventricular free wall on TSI imaging at VV of 0 ms improved with progressively increasing LV pre-excitation to 40 ms. There was progressive decrease in septoposterior and septolateral delay with increasing LV pre-excitation (Figure 6) along with an improvement in LV ejection duration (Figure 7). Patient reported a marked improvement in symptoms to NYHA class 1 at 2 week follow up.


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

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

PW Doppler showing left ventricular outflow tract velocity. Improvement in left ventricular ejection duration is shown in B during LV pre-excitation of 40 ms compared to baseline VV delay of 0 ms in A.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: PW Doppler showing left ventricular outflow tract velocity. Improvement in left ventricular ejection duration is shown in B during LV pre-excitation of 40 ms compared to baseline VV delay of 0 ms in A.
Mentions: This 67 year old Caucasian male with a history of inferior myocardial infarction and severe MR, underwent CRT and presented with an 8 week history of NYHA class III symptoms 15 months post CRT. Pacemaker was programmed at paced AV delay of 180 ms and VV delay of 0 ms following AV and VV optimization 14 months ago. He had no underlying AV conduction. There was moderate MR, LVEF was 37% and peak PAP was 40 mm Hg. There were essentially no mitral inflow A waves between an AV delay of 50 to 120 msec and marked atrial truncation was seen at an AVD of 180 ms. Progressive improvement in mitral and pulmonary vein inflow occurred with progressively increasing AV delay to 210 ms. Delay seen in the lateral, septal, inferior and posterior walls and right ventricular free wall on TSI imaging at VV of 0 ms improved with progressively increasing LV pre-excitation to 40 ms. There was progressive decrease in septoposterior and septolateral delay with increasing LV pre-excitation (Figure 6) along with an improvement in LV ejection duration (Figure 7). Patient reported a marked improvement in symptoms to NYHA class 1 at 2 week follow up.

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