title: [Assessment of regional wall motion using strain Doppler imaging during right ventricular bifocal pacing in a patient with severe congestive heart failure: a case report].
abstract: A 79-year-old man presented with dilated cardiomyopathy and chronic atrial fibrillation. A DDD pacemaker was implanted due to sick sinus syndrome. His left ventricular ejection fraction was 23%. He was repeatedly admitted with congestive heart failure. Although cardiac resynchronization therapy was attempted, insertion of a pacing lead into the coronary sinus failed. Right ventricular bifocal pacing was done. The QRS width was shortened to 155 msec during bifocal pacing and 157 msec during right ventricular outflow pacing from 221 msec during right ventricular apical pacing. Heart failure was improved from New York Heart Association class III to II. Regional wall motion was assessed by strain of the myocardium. Bifocal pacing increased stroke volume due to improvement of longitudinal dyssynchrony of the septal and lateral walls. Bifocal pacing is effective for patients with severe congestive heart failure in whom biventricular pacing therapy has failed. Strain Doppler imaging is useful for the assessment of regional wall motion during cardiac pacing.
authors.affiliation: The Second Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama.
authors.forename: Kohei
authors.initials: K
authors.lastname: Matsushita
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sumita
authors.forename: Yohei
authors.initials: Y
authors.lastname: Yamakawa
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Noriko
authors.initials: N
authors.lastname: Kawasaki
authors.forename: Katsumi
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Taima
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Uchino
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000628:therapy; D013318:Stroke Volume