Hemodynamic assessment of right, left, and biventricular pacing by peak endocardial acceleration and echocardiography in patients with end-stage heart failure

Multisite ventricular pacing acutely improves the hemodynamic status in hea rt failure, though longer-term observations require invasive procedures. Th e hemodynamics of multisite ventricular pacing were assessed by echocardiog raphy and peak endocardial acceleration (PEA) measured by a pacemaker senso r. PEA variations are highly correlated with those of dP/dt. Thirteen end-s tage heart failure patients (lep ventricular ejection fraction < 0.30) with a QRS <greater than or equal to>140 ms received a DDD PEA sensor-driven pa cemaker allowing right (RV), left (LV) and biventricular (BV) pacing. Ten d ays after implantation, standard echocardiographic parameters and variation s in PEA were measured after 20 minutes at each pacing mode. The aortic sys tolic preejection time interval was statistically comparable between RV and LV pacing (218 +/- 24 vs 219 +/- 34 ms; P = NS), and significantly shorter with BV pacing (198 +/- 27 ms; P = 0.013). Aortic ejection duration was no nsignificantly shorter during BV pacing than during LV pacing (-.061, P = 0 .09). The aortic velocity time integer increased during LV pacing versus RV pacing (+21%, P < 0.05) and during BV pacing versus RV pacing (+37%, P = 0 .05). As a result, the values of the PEA variations over a 15-minute period were significantly greater during LV pacing and BV pacing versus RV pacing (+43%, P < 0.05, and +38%, P = 0.05, respectively) and were statistically comparable between BV pacing and LV pacing (+5.9% for LV pacing, P = NS). D uring various ventricular pacing configurations, PEA measurements were cons istent with echocardiographic data, showing comparable hemodynamic effects of BV and LV pacing. The PEA sensor is a promising tool for long-term hemod ynamic monitoring and serial evaluation of the effects of multisite ventric ular pacing in heart failure patients.