Invasive optimization of cardiac resynchronization therapy: role of sequential biventricular and left ventricular pacing

Biventricular and Left Ventricular Pacing. Background: Aim of this invasive study was to characterize and quantify changes in left ventricular (LV) systolic function due to sequential biventricular pacing (BV) as comparedto right atrial triggered simultaneous BV (BV 0 ), LV, and right ventricular (RV) pacing in patients with congestive heart failure (CHF). Methods: In 22 CHF patients, all in sinus rhythm, temporary multisite pacing was performed prior to implantation of a permanent system. LV systolic function was evaluated invasively by the maximum rate of LV pressure increase (dP/dt m a x ). Sequential BV pacing was performed with preactivation of either ventricle at 20-80 ms. Results: In comparison to RV pacing, LV and BV 0 pacing increased dP/dt m a x by 33.9 ′ 19.3% and 34.0 ′ 22.6%, respectively (P < 0.001). In 9 patients, optimized sequential BV pacing further improved dP/dt m a x by 8.5 ′ 4.8% compared to BV 0 (range 3.3-17.1, P < 0.05). In 10 patients exhibiting a PR interval