Effects of Dual-Cha1nber Pacing with Short Atrioventricular-Delay in -- Dilated Cardiontyopathy

Abstract

End stage congestive heart failure ( CHF) still poses one of the greatest therapeutic challenges in modern medicine despite ad\•ances in pharmacologic & non phan'lacologic therapeutic modalities. Dual chamber (DOD) pacing with optimal A V delay has emerged in 1990 as an ingenious way of achieving synchronous LV activation and minimizing presystolic MR. However various controwrsial results have been published and the initial enthusiasm has faded away. The purpose of the present study is to evaluate the experience of the Critical Care Center of Cairo University with ..ooo•• pacing in refractory heart failure in an attempt to choose parameters that could segregate responders •'if any" from non responders.

Thirteen pts (10M, 3 F) with a mean age of55.5 y (44 y-76 y) were studied. All had CI-IF which was refractory to maximal medical treatment. Following clinical evaluation, all pts had "ODD'' pacemaker implanted under fluroscopic guidance and PR interval optimized to yield the highest cardiac output (CO). Patients were evaluated before, I 0 days later. 2 weeks. 6 weeks. 3 months up to 6 months following implantation. Besides clinical evaluation (NYI-IA class) all pts were subjected to M-mode & 2-D Echocardiography each visit with the following parameters looked for: left ventricular (LV) end diastolic diameter (LVEDD). LV end systolic diameter (L VESD). ejection fraction (EF%), fraction shortening (FS%). cardiac output (CO) Lim and E- point- septal separation (EPSS).