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Biventricular mechanical asynchrony predicts hemodynamic effect of uni- and biventricular pacing

¹Heart Failure Research Group, Guidant Corporation, St. Paul, Minnesota 55112; and ²Department of Cardiology, University Hospital, Otto-von-Guericke Universität, Magdeburg, D-39120, Germany

Submitted 5 February 2003 ; accepted in final form 13 August 2003

We tested whether biventricular resynchronization explains contractile function changes with univentricular and biventricular pacing in heart failure patients with varying magnitudes of baseline biventricular asynchrony. Thirty patients (New York Hospital Association class III, QRS duration 120 ms) were tested. Contractile function was measured by left ventricular maximum first derivative of pressure over time (dP/dt_max). Biventricular mechanical asynchrony was quantified by the normalized pressure-pressure (NPP) loop area formed by the cross-plot of right and left intraventricular pressure curves from each cardiac cycle. Any ventricular pacing increased dP/dt_max if it decreased baseline NPP loop area and almost always worsened dP/dt_max and asynchrony when baseline NPP loop area <0.3. The quantitative relationship between dP/dt_max and NPP loop area change depended on ventricular pacing site and timing relative to intrinsic activation. For similar NPP loop decreases, dP/dt_max increased 16% more with left and biventricular pacing compared with right ventricular pacing. In conclusion, right, left, or biventricular pacing can improve contractile function only in patients having sufficient baseline biventricular asynchrony. However, biventricular resynchronization is only one of the improvement mechanisms.

resynchronization; heart failure; pressure-pressure loop; intraventricular conduction delay; developed pressure over time

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