Improvement of left ventricular wall synchronization with multisite ventricular pacing in heart failure: a prospective study using Doppler tissue imaging.
We sought to assess right, left and biventricular pacing effects on myocardial function by using pulsed-Doppler tissue imaging (DTI) and automated border detection (ABD) techniques which provide electromechanical delay (EMD) assessment of the different left ventricular walls.


METHODS
15 patients (67+/-7 years) with drug-resistant primitive dilated cardiomyopathy and QRS> or =140 ms received a pacemaker for multisite ventricular pacing. Echocardiography was performed after 1 month of biventricular pacing (BVP). Echocardiographic measurements were recorded during spontaneous rhythm (SpR), right ventricular pacing (RVP), left ventricular pacing (LVP) and BVP.


RESULTS
LV ejection fraction was statistically similar between the four rhythms. BVP showed a significant EMD decrease for the lateral LV wall vs. SpR, RVP and even LVP. LVP resulted in significantly longer aortic pre-ejection time vs. BVP while the EMD temporal dispersion (time between the shortest regional EMD and the longest one) was similar in the two modes.


CONCLUSIONS
BVP and LVP substantially reduce the EMD temporal dispersion of the four LV walls, but with a longer aortic pre-ejection time for LVP. In RVP, LVP and BVP, the septal LV wall is always activated later than during SpR. BVP and LVP are associated with a mitral regurgitation reduction.
Echocardiography Laboratory, Hopital Cardiologique du Haut-Leveque, Pessac Cedex 33600, France. stephane.lafitte@chu-bordeaux.fr
Stephane
S
Lafitte
Stephane
S
Garrigue
Jean-Marie
JM
Perron
Pierre
P
Bordachar
Sylvain
S
Reuter
Pierre
P
Jaïs
Michel
M
Haïssaguerre
Jacques
J
Clementy
Raymond
R
Roudaut
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods; D018618:Echocardiography, Doppler, Color; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*