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Simultaneous vs. sequential biventricular pacing in dilated cardiomyopathy: an acute hemodynamic study
Giovanni B Perego1, Roberto Chianca, Mario Facchini
1Istituto Auxologico Italiano, Ospedale S. Luca, Via Spagnoletto 3, 20149 Milan, Italy. perego@auxologico.it
European Journal of Heart Failure
|June 12, 2003
Summary
Sequential biventricular pacing optimizes atrioventricular and interventricular delays, significantly improving left ventricular systolic performance in heart failure patients. This method offers a hemodynamic advantage over simultaneous pacing in selected cases.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Dilated cardiomyopathy and intraventricular conduction delay impair left ventricular (LV) systolic function.
- Simultaneous biventricular pacing is established to improve LV performance.
Purpose of the Study:
- To investigate if sequential biventricular pacing, by optimizing atrioventricular and interventricular delays, can further enhance LV systolic performance compared to simultaneous pacing.
- To determine optimal interventricular delays for sequential pacing.
Main Methods:
- Acute hemodynamic measurements of LV and RV pressure and dP/dt in 12 patients.
- Comparison of sequential vs. simultaneous biventricular pacing with varying atrioventricular and interventricular (VVi) intervals (-60 to +40 ms).
Main Results:
- Sequential biventricular pacing resulted in a significantly higher average increase in maximum LV dP/dt compared to simultaneous pacing (VDD mode: 35% vs. 29%; DDD mode: 38% vs. 34%).
- Optimal interventricular delays averaged -25 ms in both VDD and DDD modes, indicating a preference for early LV stimulation.
- Right ventricular dP/dt remained unchanged, and QRS shortening did not predict LV dP/dt improvement.
Conclusions:
- Sequential biventricular pacing can significantly increase LV systolic performance without affecting RV function.
- Optimizing interventricular delay, specifically stimulating the LV before the RV, yields the greatest hemodynamic benefit.
- This approach may offer clinical significance for select heart failure patients.