Optimization of Cardiac Resynchronization Therapy by Continuous Hemodynamic Monitoring:

We report the case of a 55-year-old male patient with severe congestive heart failure in whom both a hemodynamic monitor and a biventricular pacemaker were implanted. The potential usefulness of the monitor to optimize AV delay and heart rate was prospectively evaluated. The AV delay associated with the lowest filling pressures recorded by the monitor was similar to the optimal AV delay as determined by standard echocardiography. Heart rates >70 beats/min acutely improved hemodynamics but were not tolerated when programmed chronically. This case illustrates that continuous hemodynamic monitoring may offer a useful tool for device tuning and treatment monitoring in cardiac resynchronization therapy.