Abstract
Simultaneous electrical stimulation of both ventricles in patients with interventricular conduction disturbance and advanced heart failure improves hemodynamics and results in increased exercise tolerance, quality of life. We have developed a novel technique for the assessment and optimization of resynchronization therapy. Our approach is based on transthoracic dynamic three-dimensional (3D) echocardiography and allows determination of the most delayed contraction site of the left ventricle (LV) together with global LV function data. Our initial results suggest that fast reconstruction of the LV is feasible for the selection of the optimal pacing site and allows identifying LV segments with dyssynchrony.
Highlights
Simultaneous electrical stimulation of both ventricles in patients with interventricular conduction disturbance and advanced heart failure improves hemodynamics and results in increased exercise tolerance, quality of life [1,2,3]
Images are obtained with the patient in the left lateral decubitus position with the transducer in the apical position and the image plane rotating around the left ventricle (LV) long axis
Our major finding is that transthoracic dynamic 3D echocardiography performed by a fast rotating transducer and combined with automated contour analysis is feasible to determine mechanical asynchrony during LV contraction
Summary
Simultaneous electrical stimulation of both ventricles in patients with interventricular conduction disturbance and advanced heart failure improves hemodynamics and results in increased exercise tolerance, quality of life [1,2,3]. Our approach is based on transthoracic dynamic three-dimensional (3D) echocardiography and allows determination of the most delayed contraction site of the left ventricle (LV) together with global LV function data. The program performs a dynamic surface rendered endocardial reconstruction of the LV in sinus rhythm and in the different pacing modes. The difference in time to maximal myocardial contraction between segments is used to assess and measure regional mechanical delay and dyssynergy (Movies 1, 2 and 3 – see additional file 1, additional file 2 and additional file 3 respectively). Our initial results suggest that fast reconstruction of the LV is feasible for the selection of the optimal pacing site and allows identifying LV segments with dyssynchrony. Real time three-dimensional echocardiography is available, and the optimal pacing site can be determined on-line
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