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J Am Coll Cardiol, 1998; 32:1825-1831
© 1998 by the American College of Cardiology Foundation
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Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure

Christophe Leclercq, MDa, Serge Cazeau, MD*, Hervé Le Breton, MDa, Philippe Ritter, MD*, Philippe Mabo, MDa, Daniel Gras, MD*, Dominique Pavin, MDa, Arnaud Lazarus, MD* and Jean-Claude Daubert, MDa

a Département de Cardiologie, Hopital Pontchaillou, Rennes, France
* centre chirurgical de val d’or, St. Cloud, France



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  		Figure 1 Periprocedural X-ray frontal view showing the position of the intracardiac leads. RAA = right atrial appendage; CS-LA = coronary sinus for left atrial pacing; LV = left ventricle through a lateral vein over the LV-free wall; RVA = right ventricular apex; RPA = right pulmonary artery (Swan-Ganz catheter).

 


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  		Figure 2 Surface ECG (25 mm/s) showing the effects on QRS duration of switching from the AAI pacing mode (left side) to the biventricular DDD pacing mode (right side) at the same pacing rate. QRS duration is decreased by 110 ms (240 to 130 ms).

 


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  		Figure 3 Acute hemodynamic effects of temporary biventricular DDD pacing in a class III patient with ischemic cardiomyopathy. Switching from AAI to biventricular DDD pacing at the same pacing rate produces an instantaneous decrease in pulmonary capillary wedge pressure (PCWP) (mean and systolic peak) and a 32% increase in cardiac output, while the QRS duration is decreased by 35% (200 to 130 ms).

 


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  		Figure 4 Intracardiac ECG recording at the sites of the earliest (inferior base of the right ventricle close to the tricuspid annulus) and of the latest ventricular activation (posterolateral base of the left ventricle). The interventricular conduction delay is 190 ms.

 




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