- 作者：Vanessa Cobb ; Martin Thomas ; Susan Ellery ; Simon Jewell ; Lorraine Lee ; Rachael James ; Sean O¡¯Nunain ; David Hildick-Smith
- 关键词：Heart failure ; Biventricular pacing ; Echocardiography ; Optimisation ; Non-responder
- 刊名：Heart, Lung and Circulation
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：22
- 期：9
- 页码：717-723
- 全文大小：195 K
Background
We aimed to assess whether echocardiographically-optimised atrioventricular (AV) and interventricular (VV) delay programming provided any additional benefit over standard settings following biventricular pacemaker implantation in patients with advanced heart failure.Methods
Paired data were collected on 22 patients (aged 67.5 ¡À 8.3 years, 16 male) with refractory heart failure, NYHA class III/IV symptoms, sinus rhythm, LBBB and a broad QRS complex >120 ms. All patients underwent implantation of a biventricular pacemaker and were randomised to eight weeks of factory pacing mode (Mode 1) or echocardiographically-guided pacing mode (Mode 2), followed by eight weeks in the alternate mode, in a randomised blinded crossover design.
Results
Peak oxygen consumption, 6 min walk distance, NYHA class and quality of life scores improved after biventricular pacing, but no significant difference was found between the two modes, with the exception of peak oxygen consumption score (baseline: 14.8 ¡À 0.9, Mode 1: 14.6 ¡À 1.2, Mode 2: 16.1 ¡À 1.2 mL/kg/min), which was better in Mode 2 than Mode 1 (p 0.003).
Conclusion
Transthoracic echocardiographic optimisation of AV and VV delays following biventricular pacing may offer additional clinical benefit in an unselected group of patients when compared with factory settings.