Acute effects of biventricular pacing in heart failure patients with a normal ejection fraction and mechanical dyssynchrony.

Abstract:

OBJECTIVES:We tested the acute effects of resynchronization in heart failure patients with a normal (>50%) left ventricular (LV) ejection fraction (HFNEF) and mechanical dyssynchrony. METHODS:Twenty-four HFNEF patients (72 ± 6 years, 5 male) with mechanical dyssynchrony (standard deviation of electromechanical time delay among 12 LV segments >35 ms) were studied with temporary pacing catheters in the right atrium, LV, and right ventricle (RV), and high-fidelity catheters for pressure recording. Using selected atrioventricular (AV) intervals of 60, 90, 120, 150, and 180 ms to optimize transmitral flow during simultaneous biventricular pacing, the RV-LV (VV) interval was then evaluated at RV30, RV15, 0, LV15, LV30, and LV45 (RV or LV indicates which ventricle was paced first, the number indicates by how many ms). RESULTS:During simultaneous pacing, longer AV intervals were associated with improved LV pressure-derivative minimums and increased aortic pressures (p < 0.05 vs. normal sinus rhythm). In the VV interval from RV30 to LV45, there was a graded increase in the aortic velocity time integral and a decrease in dyssynchrony during simultaneous or LV-first pacing (p < 0.05 vs. normal sinus rhythm). CONCLUSIONS:For HFNEF patients with mechanical dyssynchrony, acute simultaneous biventricular or LV-first pacing with longer AV intervals reduced mechanical dyssynchrony and improved diastolic and systolic hemodynamics.

journal_name

Cardiology

journal_title

Cardiology

authors

Wang YC,Yu CC,Chiu FC,Splett V,Klepfer R,Hilpisch K,Tsai CT,Lai LP,Hwang JJ,Lin JL

doi

10.1159/000368795

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

112-9

issue

2

eissn

0008-6312

issn

1421-9751

pii

000368795

journal_volume

130

pub_type

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