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Circulation. 2002;106:2078-2084
Published online before print September 30, 2002, doi: 10.1161/01.CIR.0000034512.90874.8E
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(Circulation. 2002;106:2078.)
© 2002 American Heart Association, Inc.


Clinical Investigation and Reports

Sequential Versus Simultaneous Biventricular Resynchronization for Severe Heart Failure

Evaluation by Tissue Doppler Imaging

Peter Sogaard, MD, DMSc; Henrik Egeblad, MD, DMSc; Anders K. Pedersen, MD, DMSc; Won Yong Kim, MD, PhD; Bent Ø. Kristensen, MD, DMSc; Peter S. Hansen, MD, DMSc; Peter T. Mortensen, MD

From the Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark.

Correspondence to Peter Sogaard, MD, DMSc, Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, DK 8200 Aarhus N, Denmark. E-mail psogaard{at}dadlnet.dk

Background— Cardiac resynchronization therapy (CRT) by means of simultaneous biventricular pacing improves left ventricular systolic performance and synchrony in patients with heart failure and bundle-branch block. We used tissue tracking and 3D echocardiography to evaluate the impact of sequential CRT with individualized interventricular delay programming.

Methods and Results— Twenty consecutive patients with severe heart failure and left bundle-branch block were included. Tissue tracking and 3D echocardiography were carried out before and on the day after pacemaker implantation. Eleven different interventricular delays were examined in each patient. Patients were reexamined after 3 months. Simultaneous CRT immediately reduced the extent of myocardium displaying delayed longitudinal contraction (DLC) from 48.6±16% to 23.2±13% (P<0.01) and increased left ventricular ejection fraction percentage (LVEF%) from 22.4±6% to 29.7±5% (P<0.01). However, optimum sequential CRT caused a further reduction in the extent of DLC from 23.2±13% to 11.1±7.2% (P<0.01), with a simultaneous increase in LVEF% (from 29.7±5% to 33.9±6%, P<0.01). Three months of optimum sequential CRT further improved LVEF% (from 33.6±6% to 38.6±7.2%, P<0.01). Tissue tracking detected the segments with DLC, and their location determined optimum interventricular delay programming. Compared with simultaneous CRT, sequential CRT increased diastolic filling time by 7±2.5%.

Conclusions— Compared with simultaneous CRT, sequential CRT significantly improves left ventricular systolic and diastolic performance. Tissue tracking can be used to select optimum interventricular delay during CRT.


Key Words: imaging • echocardiography • heart failure • bundle-branch block • pacing




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CirculationHome page
C.-M. Yu, J. W.-H. Fung, Q. Zhang, C.-K. Chan, Y.-S. Chan, H. Lin, L. C.C. Kum, S.-L. Kong, Y. Zhang, and J. E. Sanderson
Tissue Doppler Imaging Is Superior to Strain Rate Imaging and Postsystolic Shortening on the Prediction of Reverse Remodeling in Both Ischemic and Nonischemic Heart Failure After Cardiac Resynchronization Therapy
Circulation, July 6, 2004; 110(1): 66 - 73.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
A. Puglisi, M. Lunati, A. G.M Marullo, S. Bianchi, M. Feccia, F. Sgreccia, I. Vicini, S. Valsecchi, F. Musumeci, and E. Vitali
Limited thoracotomy as a second choice alternative to transvenous implant for cardiac resynchronisation therapy delivery
Eur. Heart J., June 2, 2004; 25(12): 1063 - 1069.
[Abstract] [Full Text] [PDF]


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HeartHome page
P D. Bella and C Carbucicchio
Non-contact left ventricular endocardial mapping for cardiac resynchronisation therapy: a "slow conduction" towards the fast solution
Heart, May 1, 2004; 90(5): 483 - 484.
[Abstract] [Full Text] [PDF]


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CirculationHome page
W. G. Stevenson and M. O. Sweeney
Single Site Left Ventricular Pacing for Cardiac Resynchronization
Circulation, April 13, 2004; 109(14): 1694 - 1696.
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J Am Coll CardiolHome page
M. R. Mehra and B. H. Greenberg
Cardiac resynchronization therapy: caveat medicus!
J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1145 - 1148.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
O. A Breithardt, P. Claus, and G. R Sutherland
Do we understand who benefits from resynchronisation therapy?
Eur. Heart J., April 1, 2004; 25(7): 535 - 536.
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Am. J. Physiol. Heart Circ. Physiol.Home page
P. Steendijk, S. A. F. Tulner, J. J. Schreuder, J. J. Bax, L. van Erven, E. E. van der Wall, R. A. E. Dion, M. J. Schalij, and J. Baan
Quantification of left ventricular mechanical dyssynchrony by conductance catheter in heart failure patients
Am J Physiol Heart Circ Physiol, February 1, 2004; 286(2): H723 - H730.
[Abstract] [Full Text] [PDF]


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CirculationHome page
C. Leclercq and J. M. Hare
Ventricular Resynchronization: Current State of the Art
Circulation, January 27, 2004; 109(3): 296 - 299.
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J Am Coll CardiolHome page
D. A. Kass
Predicting cardiac resynchronization response by qrs duration: The long and short of it
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2125 - 2127.
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CirculationHome page
W. T. Abraham and D. L. Hayes
Cardiac Resynchronization Therapy for Heart Failure
Circulation, November 25, 2003; 108(21): 2596 - 2603.
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J Am Coll CardiolHome page
J. K. Oh and J. Tajik
The return of cardiac time intervals: The Phoenix is rising
J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1471 - 1474.
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CirculationHome page
O.-A. Breithardt, C. Stellbrink, M. G. St John Sutton, T. Plappert, W. T. Abraham, A. L. Smith, D. B. DeLurgio, A. R. Leon, E. Loh, D. Z. Kocovic, et al.
Cardiac Resynchronization Therapy * Response
Circulation, September 30, 2003; 108 (13): e97 - e97.
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J Am Coll CardiolHome page
O.-A. Breithardt, C. Stellbrink, L. Herbots, P. Claus, A. M. Sinha, B. Bijnens, P. Hanrath, and G. R. Sutherland
Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block
J. Am. Coll. Cardiol., August 6, 2003; 42(3): 486 - 494.
[Abstract] [Full Text] [PDF]


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CirculationHome page
E. I. Skalidis, P. E. Vardas, H. Ukkonen, R. S.B. Beanlands, I. Burwash, R. A. de Kemp, A. S.L. Tang, C. Nahmias, E. Fallen, and M. R.S. Hill
Cardiac Resynchronization and Myocardial Oxidative Metabolism * Response
Circulation, June 24, 2003; 107 (24): e220 - e220.
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