Biventricular Pacemaker Optimization Guided by Comprehensive Echocardiography—Preliminary Observations Regarding the Effects on Systolic and Diastolic Ventricular Function and Third Heart Sound

Echocardiography-Guided Biventricular Pacemaker Optimization

“…Naqvi Echocardiography in Pacemaker Optimization of these aforementioned echo Doppler features nearly always predicts a significant improvement in the patient's functional class after optimization (5). Using this method, we have demonstrated an improvement, not only in diastolic filling parameters, LV ejection duration, and VTI, but also in MR grade, pulmonary artery pressure, as well as myocardial performance index (29), and in functional class at follow-up (30). Whether optimal mitral inflow also provides optimal preload for RV has not been evaluated and needs further study.…”

“…optimization using Ritter's method versus aortic VTI has yielded conflicting results in the same patients (21). We have shown the utility of comprehensive methods using multiple echo Doppler parameters in improving cardiac output acutely and NYHA functional class at 1 month (29,30). A recent study showed that in nonresponders to CRT, a multidisciplinary approach centered on Biv pacemaker optimization in a heart failure program, can reduce the adverse event rate, including death, transplantation, and heart failure hospitalization (31).…”

“…5). Decreased dP/dt, increased aortic preejection time, restrictive mitral and pulmonary vein inflow pattern, presence of MR, and increased pulmonary artery systolic pressure are nonspecific markers of advanced LV dysfunction and/or increased LV end diastolic and left atrial pressure, and are a useful guide during pacemaker optimization (29,30). Improvement in LV and RV dP/dt ( Fig.…”

“…However, due to variable results by individual Doppler parameters (21,22), we (29,30,33,34) and others (35,36) have used a pacemaker optimization method utilizing individual patient hemodynamics. The reader is referred to excellent reviews on pacemaker optimization using AVD (37) and VVD (38).…”

“…Evaluation of pulmonary vein flow allows indirect assessment of left atrial pressure. AVD that causes minimal atrial reversal, a systolic dominant filling pattern, and lengthening of pulmonary vein deceleration time should be used to minimize left atrial pressure(29,30) (Figs. 4, 6, and 10).…”