Echocardiography-Guided Pacemaker Optimization and Radial Artery Tonometry

Tasneem Z. Naqvi, Asim M. Rafique

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Biventricular (Biv) pacemaker optimization is underused because of time and echo skill required. We evaluated radial artery tonometry during echo-guided Biv optimization of atrioventricular (AV) and interventricular (VV) delays. Methods and Results: A total of 60 patients (67 ± 10 years) underwent simultaneous radial artery tonometry and echocardiography after Biv implant at baseline, short AV delay, and optimal AV delay. Twenty of these also underwent VV optimization. Optimal AV delay was determined by ejection duration (E-dur) of left ventricular (LV) outflow tract by pulsed-waved (PW) Doppler (LVE-dur) and mitral inflow PW Doppler pattern and optimal VV delay by LVE-dur and tissue Doppler. E-dur was also measured from radial artery pulse wave (RAE-dur). AV optimization improved LVE-dur from 249 ± 35 to 260 ± 38 ms (P < .01) and RAE-dur from 276 ± 31 ms to 284 ± 32 ms (P = .02). Correlation between LVE-dur and by RAE-dur was 0.83 (95% CI 0.75-0.92). RAE-dur was 282.53 ± 30 at baseline, 286.65 ± 36 at optimal AV delay (P < .04 vs. baseline) and 286.90 ± 35 ms (P < .04 vs. baseline) at optimal AV and VV delay in those who underwent VV optimization. Conclusions: AV and VV optimization by echocardiography produces significant improvement in LVE-dur and RAE-dur. Radial artery tonometry may provide a simple noninvasive method to assist in AV delay optimization.

Original languageEnglish (US)
Pages (from-to)583-589
Number of pages7
JournalJournal of Cardiac Failure
Issue number7
StatePublished - Sep 2008


  • Radial artery tonometry
  • biventricular pacing
  • echo Doppler
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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