Optimization of atrioventricular delay and follow-up in a patient with congestive heart failure and with bi-ventricular pacing

Japanese Heart Journal
T IshikawaA Umemura

Abstract

Cardiac function is improved by bi-ventricular pacing in patients with severe reduced cardiac function. Atrioventricular (AV) delay optimization is also important in this therapy. However, the AV delay required to achieve the optimal AV synchrony varied from time to time. We have reported that the critical AV delay that induces diastolic mitral regurgitation (MR) may represent the upper limit of the optimal AV delay. The optimal AV delay can be predicted by a simple method; slightly prolonged AV delay-interval between the end of atrial kick and complete closure of the mitral valve (duration of diastolic MR) at the AV delay setting. [Case] 60 year old Japanese male with dilated cardiomyopathy. He was repeatedly admitted to our hospital due to congestive heart failure. Ejection fraction was 14%. ECG showed complete left bundle branch block and his PQ interval was 0.22 sec. He was dependent on intravenous injections of catecolamine and could not be discharged from the hospital for over one year. Optimal AV delay was predicted as 80 msec during bi-ventricular pacing by our formula. Cardiac output was 4.9, 6.0, 5.1 l/min when the AV delay was set at 50, 80, 110 msec. Cardiac function was improved from NYHA class III to II and he has...Continue Reading

References

Nov 1, 1992·Pacing and Clinical Electrophysiology : PACE·T IshikawaM Ishii
Jul 15, 1990·The American Journal of Cardiology·M HochleitnerW Zechmann
Nov 1, 1996·Pacing and Clinical Electrophysiology : PACE·S CazeauJ Mugica
Oct 20, 1999·Pacing and Clinical Electrophysiology : PACE·T IshikawaT Usui

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Citations

Jun 17, 2003·Circulation Journal : Official Journal of the Japanese Circulation Society·Toshiyuki IshikawaSatoshi Umemura
Jan 27, 2005·Circulation Journal : Official Journal of the Japanese Circulation Society·Noriko InoueSatoshi Umemura

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