Echocardiographic evidence of a hemodynamic and clinical improvement in patients paced for heart failure

Dilated cardiomyopathy is frequently associated with electrical conduction disturbances. Development of left bundle-branch block with discoordinated v entricular contraction pattern further contributes to impaired hemodynamic performance. Biventricular pacing has evolved as a new treatment option for patients with dilated cardiomyopathy and conduction disturbances, The "ele ctrical" approach aims to normalize the disturbed contraction pattern, ther eby improving hemodynamic function by simultaneous stimulation at different ventricular sites. Acute hemodynamic improvement with biventricular pacing has been demonstrated in patients with depressed left ventricular function and delayed intraventricular conduction, Due to the variations in optimal pacing site and atrioventricular delay, individual optimization to achieve optimal hemodynamic benefit is necessary. Echocardiography has the potentia l to provide hemodynamic data by Doppler techniques and combine these with geometric information about ventricular volumes, ejection fraction, and con traction patterns, This article focuses on the use of echocardiographic tec hniques for noninvasive optimization in cardiac: pacing and presents prelim inary experience from the initial trials on multisite pacing in heart failu re. (C) 2000 by Excerpta Medica, Inc.