Left Ventricular and Biventricular Pacing in Congestive Heart Failure

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Presentation transcript:

Left Ventricular and Biventricular Pacing in Congestive Heart Failure Thomas C. Gerber, MD, Rick A. Nishimura, MD, David R. Holmes, MD, Margaret A. Lloyd, MD, Kenton J. Zehr, MD, A. Jamil Tajik, MD, David L. Hayes, MD Mayo Clinic Proceedings Volume 76, Issue 8, Pages 803-812 (August 2001) DOI: 10.4065/76.8.803 Copyright © 2001 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Relationship between right ventricular (RV) and left ventricular (LV) events in normal subjects (A) and in patients with left bundle branch block (LBBB) (B). In the normal group, LV events either precede or occur simultaneously with the RV events. In LBBB, the sequence is reversed. Times of pulmonic, tricuspid, aortic, and mitral valve openings (po, to, ao, and mo) and closings (pc, tc, ac, and mc) are indicated (reprinted with permission of the American Heart Association, from Grines et al2). Mayo Clinic Proceedings 2001 76, 803-812DOI: (10.4065/76.8.803) Copyright © 2001 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Simultaneous invasive hemodynamic assessment with microtransducer catheters and echocardiographic Doppler measurements. Atrioventricular (AV) sequential pacing with an AV delay of 140 ms (P-Synch 140) (right panel) improves left ventricular (LV) systolic pressure without increasing left atrial (LA) pressure over normal sinus rhythm (NSR) with first-degree AV block (left panel) and abolishes diastolic mitral regurgitation (arrows) (reprinted with permission of Mosby, from Symanski and Nishimura35). Mayo Clinic Proceedings 2001 76, 803-812DOI: (10.4065/76.8.803) Copyright © 2001 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Coronary venous angiogram (A) and final lead positions in posteroanterior (B) and lateral (C) views in an 82-year-old man with severe left ventricular dysfunction, left bundle branch block, and New York Heart Association class IV heart failure symptoms. The left ventricular lead (LVL) is in the left posterior vein (LPV). CS = coronary sinus; GCV = great cardiac vein; LMV = left marginal vein; RAL = right atrial lead; RVL = right ventricular lead. Mayo Clinic Proceedings 2001 76, 803-812DOI: (10.4065/76.8.803) Copyright © 2001 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Relationship between left ventricular and coronary venous anatomy. The shaded areas indicate myocardium that can be paced via coronary veins. AIVV = anterior interventricular vein; Ao = aorta; CS = coronary sinus; LA = left atrium; LMV = left marginal vein; LPV = left posterior vein; LV = left ventricle; MCV = middle cardiac vein; PA = pulmonary artery; RA = right atrium; RV = right ventricle. Mayo Clinic Proceedings 2001 76, 803-812DOI: (10.4065/76.8.803) Copyright © 2001 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 5 Pressure volume loops in a patient with severe left ventricular (LV) dysfunction and left bundle branch block during LV free wall (left panel) and biventricular (right panel) VDD pacing (dashed lines) compared with sinus rhythm (solid lines). Both pacing modes reduce the end-systolic volume and increase stroke volume (loop area) and stroke work (loop width). These effects are more pronounced with LV free wall pacing than with biventricular pacing (reprinted with permission of the American Heart Association, from Kass et al42). Mayo Clinic Proceedings 2001 76, 803-812DOI: (10.4065/76.8.803) Copyright © 2001 Mayo Foundation for Medical Education and Research Terms and Conditions