Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing
Pierre Bordachar, MD,
Stephane Lafitte, MD, PhD,
Sylvain Reuter, MD,
Prashanthan Sanders, MBBS, PhD,
Pierre Jaïs, MD,
Michel Haïssaguerre, MD,
Raymond Roudaut, MD,
Stephane Garrigue, MD, PhD* and
Jacques Clementy, MD
Hôpital Cardiologique du Haut Leveque, Pessac, France
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Figure 1 Measurements of the electro-mechanical delaypeak of the basal portion of the septal and lateral walls before the implantation, in simultaneous biventricular pacing (BVP), and in optimized sequential BVP (pre-activation of the left ventricular [LV] lead of 20 ms). Important delay (110 ms) between the two segments in spontaneous rhythm, reduction of this delay (50 ms) in simultaneous BVP, and further improvement (0 ms) in optimized sequential BVP.
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Figure 2 Correlation between the changes in the parameters of ventricular dyssynchrony and those of cardiac output (CO). A high correlation is shown between the changes in the index of dyssynchrony, the intraventricular delaypeak, and the changes in CO; lower correlation for the extent of myocardium displaying delayed longitudinal contraction (DLC); no correlation for the interventricular delay (intra-LV delay). LV = left ventricular.
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Figure 3 Correlation between the changes in the parameters of ventricular dyssynchrony and those of mitral regurgitation (MR). A high correlation is shown between the changes in the index of dyssynchrony, the intra-LV delaypeak, and the changes in MR; lower correlation for the extent of myocardium displaying DLC; no correlation for the interventricular delay. Abbreviations as in Figure 2.
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Figure 4 Reduction of mitral regurgitation with optimized sequential biventricular pacing (BVP). Pre-implant effective regurgitant orifice area (EROA): 31 mm2; simultaneous BVP EROA: 22 mm2; sequential BVP with right ventricular (RV) pre-activation of 40 ms EROA: 21 mm2; optimized sequential BVP with left ventricular (LV) pre-activation of 40 ms EROA: 10 mm2.
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