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(Circulation. 2001;103:e98.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Resynchronization Therapy in Dilated Cardiomyopathy

Confirmation of Hemodynamic Improvement With Real-Time Three-Dimensional Echocardiography

Antonio J. Chamoun, MD; Daniel J. Lenihan, MD; Marti McCulloch, RDCS; Masood Ahmad, MD; Richard G. Sheahan, MD

From the Division of Cardiology at the University of Texas Medical Branch at Galveston, Tex.

A 66-year-old woman, with a history of severe idiopathic dilated cardiomyopathy and an implantable cardioverter defibrillator for ventricular tachyarrhythmia, presented with New York Heart Association (NYHA) class IV congestive heart failure (CHF). Her medical regimen had been optimized with maximally tolerated doses of ACE inhibitors, ß-blockers, loop diuretics, spironolactone, and digoxin. Initially, her ECG showed a first-degree atrioventricular block (PR duration, 280 ms) and intraventricular conduction delay (QRS duration, 180 ms). Subsequently, she developed symptomatic sinus node dysfunction with junctional escape rhythm. Because the patient had recurrent exacerbations of CHF, a dual-chamber pacemaker with a left ventricular pacing lead positioned in the lateral branch of the coronary sinus was placed to optimize atriobiventricular synchrony. Real-time 3D echocardiographic-derived stroke volumes were measured during atrial (cine loop 1) and atriobiventricular (cine loop 2) pacing at 80 bpm. The Figure shows the end-diastolic and end-systolic frames during the respective pacing modes. Stroke volume was augmented from 42 mL · s during native sequence activation to 58 mL · s during atriobiventricular pacing. Over the next 3 months, the patient had improved CHF with NYHA class III symptoms.

View larger version (112K): [in this window] [in a new window]   Figure 1. Three-dimensional echocardiographic left ventricular end-diastolic and end-systolic frames during atrial (AAI) and atriobiventricular (BiVent) pacing. RV indicates right ventricle; LV, left ventricle; RA, right atrium; and LA, left atrium.

This case illustrates the potential early benefit of resynchronization therapy as a nonpharmacological adjuvant in the management of patients with severe CHF. Real-time 3D echocardiography may be a useful noninvasive tool to predict those patients who may benefit most from this new therapeutic modality.

Footnotes

Cine loops 1 and 2 can be found Online at http://www.circulationaha.org

Correspondence to Richard G. Sheahan, MD, Associate Professor of Medicine, University of North Carolina at Chapel Hill, Division of Cardiology, CB# 7075, 324 Burnett-Womack Building, Chapel Hill, NC 27599-7075.

This Article Full Text (PDF) Cine images Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chamoun, A. J. Articles by Sheahan, R. G. Search for Related Content PubMed PubMed Citation Articles by Chamoun, A. J. Articles by Sheahan, R. G. Related Collections Congestive Pacemaker Myocardial cardiomyopathy disease Echocardiography Arrhythmias, clinical electrophysiology, drugs