Echocardiography-guided biventricular pacemaker optimization: role of echo Doppler in hemodynamic assessment and improvement

Abstract

In spite of improvements in heart failure management and increasing utilization of cardiac resynchronization therapy (CRT), approximately 30-40% of CRT patients remain nonresponders and 50% or more are echocardiographic nonresponders (defined as less than 15% reduction in left ventricular end systolic volume post-CRT). Optimization guided by echocardiography has been studied as one of the methods to improve the nonresponder rate to CRT. Echo-guided biventricular (Biv) pacemaker optimization has been associated with improvement in acute cardiac hemodynamics and improvement in functional class. In this review, the authors discuss various methods to optimize Biv pacemaker by echocardiography, recent advances in pacemaker optimization and the limitations of echocardiography. The authors also demonstrate complex hemodynamic derangements in heart failure via multiple case examples highlighting the role of comprehensive echo Doppler in elucidating cardiac hemodynamics encountered in CRT nonresponders, as well as tailoring of Biv pacemaker optimization to the underlying physiologic derangement.

Long-term clinical effects of programmer-guided atrioventricular and interventricular delay optimization: Intracardiac electrography versus echocardiography for cardiac resynchronization therapy in patients with heart failure

“…18,31 Intracardiac electrography can accurately determine the duration of atrial activation and paced conduction properties of both ventricles, ensuring ventricle contraction begins after the mitral valve is completely closed, thereby reducing mitral regurgitation while maximizing left atrial preload. 32 In addition, it ensures that both ventricular conduction waves and selfpacing stimuli arrive at the ventricular septum simultaneously, optimizing the AV/ VV intervals. 33 QuickOpt Õ is rapid ($1 min) and simple to perform, does not require special training and incurs no additional costs.…”

Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

“…Other studies were stricter and used a 15% threshold. 29,30 Third, clinical response was based only on improvement in NYHA class and did not include assessment of functional capacity or quality of life scores. Fourth, echocardiographic parameters depend on the operator and there will always be a degree of intra-and interobserver variability.…”

Long-Term Effect of Different Optimizing Methods for Cardiac Resynchronization Therapy in Patients with Heart Failure: A Randomized and Controlled Pilot Study

“…Intracardiac electrography can accurately determine the duration of atrial activation and paced conduction properties of both ventricles, ensuring ventricle contraction begins after the mitral valve is completely closed, thereby reducing mitral regurgitation while maximizing the left atrial preload [25]. In addition, it ensures that both ventricular conduction waves and self-pacing stimuli arrive at the ventricular septum simultaneously, optimizing the AV/VV intervals [26].…”