Echocardiography-Guided Biventricular Pacemaker Optimization

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.