© 2002 European Society of Cardiology
Simultaneous vs. sequential biventricular pacing in dilated cardiomyopathy: an acute hemodynamic study
a Istituto Auxologico Italiano Ospedale S. Luca, Via Spagnoletto 3, 20149 Milan, Italy
b Medtronic Italia Via le Testi 280, 20100 Milan, Italy
* Corresponding author. Tel.: +39-2-58216799; fax: +39-2-58216721. E-mail address: perego{at}auxologico.it
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Abstract |
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Aims: Simultaneous biventricular pacing improves left ventricular (LV) systolic performance in patients with dilated cardiomyopathy and intraventricular conduction delay. We tested the hypothesis that further improvements can be obtained using sequential biventricular pacing by optimizing both atrioventricular and interventricular delays.
Methods and results: In 12 patients, LV pressure, right ventricular (RV) pressure and respective rates of change of pressure (dP/dt) were acutely measured during biventricular pacing with different atrioventricular and interventricular (VVi) intervals ranging from –60 to +40 ms. The average increase vs. baseline in maximum LV dP/dt was higher for sequential than for simultaneous biventricular pacing (VDD mode: 35±20 vs. 29±18%, P<0.01; DDD mode: 38±23 vs. 34±25%, P<0.01), with a minority of patients accounting for most of the difference. The mean optimal VVi was –25±21 ms in VDD mode and –25±26 ms in DDD mode. With these settings, RV dP/dt was not significantly different from baseline. QRS shortening was not predictive of LV dP/dt increase.
Conclusion: A significant increase of LV dP/dt with no change in RV dP/dt can be obtained by sequential biventricular pacing as compared to simultaneous biventricular pacing. The highest LV dP/dt is achieved when LV is stimulated before RV. The hemodynamic advantage might be of clinical significance in selected cases.
Key Words: Heart failure • Hemodynamics • Pacing • Cardiac resynchronization therapy • Sequential biventricular pacing
Received February 26, 2002; Revised June 5, 2002; Accepted October 3, 2002
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