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Europace Advance Access published online on March 11, 2008
Europace, doi:10.1093/europace/eun059
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Resynchronization of the left ventricular contraction by tailored programming of right and left ventricular pacing

Michele Brignole*, Daniele Oddone, Roberto Maggi, Gabriele Lupi, Roberto Bollini, Serena Corallo, Stefano Robotti, Alberto Solano, Paolo Donateo and Francesco Croci

Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Via don Bobbio, 16033 Lavagna, Italy

Aims: The prerequisite and the rationale for the benefit of cardiac resynchronization therapy (CRT) is that it is able to resynchronize left ventricular (LV) walls that have a delayed activation.

Methods and results: In 69 consecutive patients who underwent biventricular (BIV) pacemaker implantation, we assessed the magnitude of intraventricular resynchronization achieved by means of simultaneous (BIV 0) and sequential BIV pacing (with an individually optimized VV interval value among +80 ms and –80 ms) using pulsed-wave tissue Doppler imaging techniques and in particular the measurement of the intra-LV electromechanical delay. The intra-LV delay was defined as the difference between the longest and the shortest activation time in the six basal segments of the LV. An abnormal intra-LV delay was defined as a value >41 ms. The intra-LV delay was 63 ± 28 ms baseline, decreased to 44 ± 26 ms with BIV 0 and to 26 ± 15 ms with optimized BIV (P = 0.001). BIV 0 determined the shortest delay in 28 (41%) patients (23 ± 12 ms). In 41 (59%) patients, a better resynchronization was achieved with optimized VV intervals (LV first in 32 and RV first in 5) or single-chamber pacing (LV in 3 and RV in 1). With BIV 0, the intra-LV delay remained abnormal in 41% and was longer than baseline in 30% of patients compared with 9 and 12% with optimized BIV, respectively (P = 0.001).

Conclusion: A sub-optimal resynchronization is achieved with simultaneous BIV pacing in most patients. A tailored programming of the relative contribution of RV and LV pacing forms the prerequisite for improving CRT results.

Key Words: Cardiac resynchronisation therapy, Dyssynchrony, Tissue Doppler imaging

* Corresponding author. Tel: +39 0185 329 567; fax: +39 0185 306 506. E-mail address: mbrignole{at}asl4.liguria.it

Manuscript submitted 17 October 2007. Accepted after revision 18 February 2008.


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