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Visual LV motion and invasive LVdP/dtmax for selection and optimisation of cardiac resynchronisation therapy

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Abstract

Echocardiography shows that multiphasic septal movement and a septal to lateral apical systolic left ventricular (LV) motion have a high predictive value for dyssynchrony and the response to cardiac resynchronisation therapy (CRT). Presence of dyssynchrony is also the major marker for CRT response in the presence of scar tissue, provided the interventricular (V-V) pacing interval is optimalised. For atrioventricular (AV) interval optimisation, the velocity-time integral of the transmitral flow has an excellent correlation with invasive LVdP/dtmax. In acute haemodynamic measurements, LVdP/dtmax shows strongly the effect of AV and V-V optimisation. It also illustrates that the haemodynamic effect of LV pacing when associated with intrinsic conduction over the right bundle is equal to or better than biventricular pacing. We found that once AV and V-V interval were optimised, QRS morphology could be used as a template for optimal therapy. Automated continuous optimisation of the pacing intervals will be the big challenge for the future. (Neth Heart J 2008;16(suppl 1):S32-S35).

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    B. M. van Gelder

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  1. A. H. M. Jansen
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  2. B. M. van Gelder
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Correspondence to B. M. van Gelder.

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Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands

B.M. van Gelder Department of Cardiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands

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Jansen, A.H.M., van Gelder, B.M. Visual LV motion and invasive LVdP/dtmax for selection and optimisation of cardiac resynchronisation therapy. NHJL 16, 31–34 (2008). https://doi.org/10.1007/BF03086203

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