Inadvertent QRS prolongation by an optimization device-based algorithm in patients with cardiac resynchronization therapy

Device-based algorithms offer the potential for automated optimization of cardiac resynchronization therapy (CRT), but the process for accepting them into clinical use is currently still ad-hoc, rather than based on pre-clinical and clinical testing of specific features of validity. We investigated...

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Veröffentlicht in:PloS one 2022-09, Vol.17 (9), p.e0275276-e0275276
Hauptverfasser: Sedlácek, Kamil, Polásek, Rostislav, Jansová, Helena, Grieco, Domenico, Kucera, Pavel, Kautzner, Josef, Francis, Darrel P, Wichterle, Dan
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Sprache:eng
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Zusammenfassung:Device-based algorithms offer the potential for automated optimization of cardiac resynchronization therapy (CRT), but the process for accepting them into clinical use is currently still ad-hoc, rather than based on pre-clinical and clinical testing of specific features of validity. We investigated how the QuickOpt-guided VV delay (VVD) programming performs against the clinical and engineering heuristic of QRS complex shortening by CRT. A prospective, 2-center study enrolled 37 consecutive patients with CRT. QRS complex duration (QRSd) was assessed during intrinsic atrioventricular conduction, synchronous biventricular pacing, and biventricular pacing with QuickOpt-proposed VVD. The measurements were done manually by electronic calipers in signal-averaged and magnified 12-lead QRS complexes. Native QRSd was 174 ± 22 ms. Biventricular pacing with empiric AVD and synchronous VVD resulted in QRSd 156 ± 20 ms, a significant narrowing from the baseline QRSd by 17 ± 27 ms, P = 0.0003. In 36 of 37 patients, the QuickOpt algorithm recommended left ventricular preexcitation with VVD of 42 ± 18 ms (median 40 ms; interquartile range 30-55 ms, P
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0275276