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Cardiac resynchronization therapy is an established therapy for heart failure patients with sinus rhythm, reduced left ventricular ejection fraction and prolongation of QRS duration. The aim of the study was to evaluate ventricular desynchronization with electrical interventricular delay (IVD) to left ventricular delay (LVD) ratio in atrial fibrillation heart failure patients. IVD and LVD were measured by transesophageal posterior left ventricular ECG recording. In atrial fibrillation heart failure patients with prolonged QRS duration, the mean IVD-to-LVD-ratio was 0.84 +/- 0.42 with a range from 0.17 to 2.2 IVD-to-LVD-ratio. IVD-to-LVD-ratio correlated with QRS duration. IVD-to-LVD-ratio may be a useful parameter to evaluate electrical ventricular desynchronization in atrial fibrillation heart failure patients.
Cardiac resynchronization therapy with atrioventricular and interventricular pacing delay optimized biventricular pacing is an established therapy for heart failure patients with sinus rhythm and reduced left ventricular ejection fraction. The aim of the study was to evaluate atrioventricular and interventricular pacing delay optimization in cardiac resynchroniza-tion therapy by transthoracic impedance cardiography in biventricular pacing with different left ventricular electrode po-sition. In biventricular pacing heart failure patients with lateral, posterolateral and anterolateral left ventricular electrode position, the mean optimal atrioventricular sening delay was 108.6 ± 20.3 ms and the mean optimal interventricular pac-ing delay -12.3 ± 25.9 ms. Transthoracic impedance cardiography may be a useful technique to optimize atrioventricular and interventricular pacing delay in biventricular pacing with different left ventricular electrode position.
Decrease of non-responder rate is the main chal-lenge in cardiac resynchronization therapy. The problem could be solved, partly, in the follow-up by consequent indi-vidualization of hemodynamic pacing parameters. The eso-phageal electrogram feature of the Biotronik ICS 3000 programmer was used in the follow-up of 20 heart failure patients carrying implants for cardiac resynchronization therapy. Adverse hemodynamic programming of the sensed and paced AV delay could be easily observed and replaced by the individual optimal duration in 3 patients (15%) VDD and DDD operation.This result proves the value of esophageal electrogram recording CRT follow-up.