RESULTS OF ATRIOVENTRICULAR SYNCHRONOUS PACING WITH OPTIMIZED DELAY IN PATIENTS WITH SEVERE CONGESTIVE-HEART-FAILURE

To verify that atrioventricular (AV) synchronous pacing (DDD) with sho rt AV delay Improves the condition of patients with severe congestive heart failure, we implanted DDD pacemakers in 10 patients with severe heart failure (New York Heart Association [NYHA] class III to IV). One day after pacemaker implantation, the AV delay was optimized by Doppl er echocardiographic measurements over the aortic outflow tract. patie nts were evaluated regarding NYHA class, stroke volume, cardiac output , ejection fraction, and quality of life at 1, 3, and 6 months after p acemaker implantation. Although the optimized AV delay was associated with short-term improvement in stroke volume and cardiac output (basel ine stroke volume = 22 +/- 7 ml, day 1 = 28 +/- 12 ml; p = 0.03: basel ine cardiac output 1.9 +/- 0.6 L/min, day 1 = 2.2 +/- 1.1 L/min; p 0.1 0), the mean stroke volume, cardiac output, NYHA class, and ejection f raction did not change significantly after 1, 3, and 6 months of pacin g compared with baseline values. Three patients improved in NYHA class during the follow-vp. A consistent improvement in stroke volume, card iac output, NYHA class, and ejection fraction was observed in only 1 p atient. In conclusion, we found no beneficial effects of AV-synchronou s pacing with optimized AV delay in patients with severe heart failure .