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.
Echo - Inside Out Upside Down : Echo - Inside Out Upside Down V to V Synchrony A to A Synchrony A to V Synchrony
A to V Optimization : A to V Optimization
Slide4 : LVOT VTI - Stroke Volume
Ritter Method
Iterative Method
Impedance Cardiology (ICG)
Intracardiac Electrogram Method (IEGM - Quick Op) AV Optimization Methods
Bringing Together The Team : Bringing Together The Team Pacemaker
Nures/Tech Sonographer Echocardiographer Heart Failure
Team EP
Team
Slide6 : AV Synchrony Mitral Inflow Method Optimized ECG
Fast sweep speed
Low filters
Minimize scale Technical Tips ( Doppler )
Slide7 : Mitral Inflow Method ( R and Closure Click ) Early LV Activation A A E E E A
Late LV Activation & Diastolic MR : Late LV Activation & Diastolic MR
Mitral Inflow Method ( R and Closure Click ) Late LV Activation : Mitral Inflow Method ( R and Closure Click ) Late LV Activation Diastolic MR
Slide10 : 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
Sensed vs Paced AV Delay : Sensed vs Paced AV Delay No left atrial lead
Slide12 : IVRT And Filling Time Heart rate 70
( filling time 400 msec ) IVRT normally about 100 msec.
Slide13 : IVRT And Filling Time Heart rate 60
( filling time 600 msec ) Heart rate 70
( filling time 400 msec )
Optimization of Heart Rate : Optimization of Heart Rate DDD50 PAV220 DDD60 PAV220
DDD70 PAV220
Choosing the correct heart rate: a therapy adjustment
Low Output State : Low Output State Baseline Post PVC
Valsalva Technique : Valsalva Technique
Valsalva : Valsalva Baseline Peak Valsalva
Slide18 : Question #1 This is:
1. Low output state
2. Long IVRT
3. Late activation of the left ventricle
4. Early activation of the left ventricle
5. Optimal AV delay
Slide19 : Question #2 This is:
1. Low output state
2. Long IVRT
3. Late activation of the left ventricle
4. Early activation of the left ventricle
5. Optimal AV delay
Slide20 : Question #3 This is:
1. Low output state
2. Long IVRT
3. Late activation of the left ventricle
4. Early activation of the left ventricle
5. Optimal AV delay
Slide21 : Question #4 This is:
1. Low output state
2. Long IVRT
3. Late activation of the left ventricle
4. Early activation of the left ventricle
5. Optimal AV delay
Slide22 : Question #5 This is:
1. Low output state
2. Long IVRT
3. Late activation of the left ventricle
4. Early activation of the left ventricle
5. Optimal AV delay