Pacemaker Optimization The Role of Echocardiography Mark J. Harry R.D.C.S. : Pacemaker Optimization The Role of Echocardiography Mark J. Harry R.D.C.S.
Slide2 : Modified Lead II ECG
Slide3 : AV Optimization Technique R wave of the ECG on the closure click of the mitral valve and/or onset of MR means activation of the LV at the end of atrial contribution to LV filling ( Left heart AV synchrony ).
Slide4 : Early LV Activation Baseline
Late LV Activation : Late LV Activation Diastolic MR Baseline
Slide6 : Intrinsic Conduction & AV Optimization Intrinsic Conduction Paced Conduction Intrinsic Conduction Paced Conduction Fusion Intrinsic Conduction Paced Conduction Ideal Bi-V pacing
No atrial contribution Ideal atrial contribution
No Bi V pacing Compromise
Optimization of Heart Rate : Optimization of Heart Rate PAV220 PAV220
PAV220
Choosing the correct heart rate: A therapy adjustment
Slide8 : Other Heart Rate Considerations Heart rate 70 Heart rate 60 Prolonged IVRT and filling time too short at a heart rate of 70
MR from R wave to P wave at a heart rate of 70
Paradoxical Septal Motion : Paradoxical Septal Motion
RVOT & LOVT Pre-ejection Time : RVOT & LOVT Pre-ejection Time ≥ 40 msec. difference is significant RVOT LVOT 60 year old female
with a LBBB
EF 48%
Slide11 : Intraventricular Dyssynchrony Tissue Doppler Image provided by Alex Neumann
Slide12 :
Tissue Synchronous Imaging (TSI) : Tissue Synchronous Imaging (TSI)
Slide14 :
3D Volumes : 3D Volumes
Slide16 :
Suggested Reading : Suggested Reading The first two books can be obtained at cardiotext.com