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Novel method of biventricular pacemaker optimization by radial artery tonometer. A case report
1Cardiac Noninvasive Laboratory, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Minerva Cardioangiologica
|May 31, 2007
Summary
Echocardiography and pulse waveform analysis improve cardiac function in nonresponders to cardiac resynchronization therapy (CRT). This noninvasive method aids in optimizing biventricular pacemaker settings for better patient outcomes.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) improves cardiac function but requires precise pacemaker optimization.
- Nonresponders to CRT often need further adjustments to biventricular pacemaker settings.
- Noninvasive methods for optimizing pacemaker function are desirable to simplify the procedure.
Observation:
- A 73-year-old male with ischemic cardiomyopathy and NYHA class III symptoms post-CRT presented for optimization.
- Optimal atrioventricular (AV) delay was determined using pulsed wave (PW) echo Doppler and radial artery pulse waveform analysis.
- No significant atrial mechanical activity was observed despite sinus rhythm up to an AV delay of 190 ms.
Findings:
- Echocardiography-guided pacemaker optimization significantly improved cardiac function in CRT nonresponders.
- Simultaneous radial artery pulse waveform analysis by tonometry provided complementary data during AV delay optimization.
- Ventricular-ventricular (VV) optimization using tissue Doppler imaging (TDI) further enhanced cardiac function and reduced mechanical dyssynchrony.
Implications:
- Individualized biventricular pacemaker optimization is crucial for patients undergoing CRT.
- Radial artery pulse waveform analysis, PW echo Doppler, and TDI can provide valuable information for pacemaker programming.
- These noninvasive techniques may simplify and enhance the effectiveness of pacemaker optimization in CRT patients.
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