Echocardiographic Laboratories, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
JACC Cardiovasc Imaging. 2010 Nov;3(11):1168-80. doi: 10.1016/j.jcmg.2010.06.017.
Optimization of atrioventricular delay (AVD) and interventricular delay (VVD) in patients with a biventricular (Biv) pacemaker has been associated with improvement in cardiac output acutely, a reduction in heart failure symptoms, and improved exercise capacity. Several individual echocardiography (echo) Doppler parameters have been used for pacemaker optimization. In this review, pacemaker optimization based on echocardiographic evaluation of cardiac hemodynamics is presented. The goals of this paper are to discuss studies in echo-guided pacemaker optimization, provide a systemic guide to pacemaker interrogation and optimization in patients after Biv pacing who may have complex hemodynamic derangement, and finally, to discuss studies in optimization with exercise or atrial pacing. Case examples highlighting hemodynamic derangement in heart failure, tailoring of Biv pacemaker optimization to the underlying physiologic derangement, and its improvement with optimization are presented.
优化双心室（Biv）起搏器患者的房室（AV）和室间（VV）延迟与心输出量的急性改善、心力衰竭症状的减少以及运动能力的提高有关。已经使用了几种个体超声心动图（echo）多普勒参数来进行起搏器优化。在这篇综述中，提出了基于心脏血流动力学超声心动图评估的起搏器优化。本文的目的是讨论基于超声心动图指导的起搏器优化的研究，为 Biv 起搏后可能存在复杂血流动力学紊乱的患者提供系统的起搏器检测和优化指南，最后讨论优化与运动或心房起搏的研究。通过病例示例突出心力衰竭时的血流动力学紊乱、根据潜在的生理紊乱调整 Biv 起搏器优化以及优化后的改善情况。
