A Prospective Comparison of AV Delay Programming Methods for Hemodynamic Optimization during Cardiac Resynchronization Therapy
Introduction: There are several methods for programming the optimal AV delay (AVD) during cardiac resynchronization therapy (CRT). These include Doppler echocardiographic measurements of mitral inflow or aortic outflow velocities, an arbitrarily fixed AVD, and calculations based on intracardiac elec...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2007-05, Vol.18 (5), p.490-496 |
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| creator | GOLD, MICHAEL R. NIAZI, IMRAN GIUDICI, MICHAEL LEMAN, ROBERT B. STURDIVANT, J. LACY KIM, MICHAEL H. YU, YINGHONG DING, JIANG WAGGONER, ALAN D. |
| description | Introduction: There are several methods for programming the optimal AV delay (AVD) during cardiac resynchronization therapy (CRT). These include Doppler echocardiographic measurements of mitral inflow or aortic outflow velocities, an arbitrarily fixed AVD, and calculations based on intracardiac electrogram (EGM) intervals. The present study was designed to compare the acute effects of AVD programming methods during CRT.
Methods and Results: We studied 28 patients at CRT implant with invasive measurements of LV dP/dt to determine the effect of AVD during atrial sensed (AS) and atrial paced (AP) modes. The optimal AVD, defined as that resulting in the maximal LV dP/dt, was then compared with that predicted by several noninvasive methods. CRT increased LV dP/dt 11%± 11% during AS (heart rate: 73 ± 14 bpm) and 17%± 12% during AP (heart rate: 86 ± 12 bpm) (P < 0.001 vs AS). There was an excellent correlation between the EGM method and the maximum achievable LV dP/dt (AS: R2= 0.99, P < 0.0001, AP: R2= 0.96, P < 0.0001) and this method performed better than other techniques.
Conclusions: An electrogram‐based optimization method accurately predicts the optimal AVD among patients over a wide range of QRS intervals during CRT in both AS and AP modes. This simple technique may obviate the need for echocardiography for AVD programming. |
| doi_str_mv | 10.1111/j.1540-8167.2007.00770.x |
| format | Article |
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Methods and Results: We studied 28 patients at CRT implant with invasive measurements of LV dP/dt to determine the effect of AVD during atrial sensed (AS) and atrial paced (AP) modes. The optimal AVD, defined as that resulting in the maximal LV dP/dt, was then compared with that predicted by several noninvasive methods. CRT increased LV dP/dt 11%± 11% during AS (heart rate: 73 ± 14 bpm) and 17%± 12% during AP (heart rate: 86 ± 12 bpm) (P < 0.001 vs AS). There was an excellent correlation between the EGM method and the maximum achievable LV dP/dt (AS: R2= 0.99, P < 0.0001, AP: R2= 0.96, P < 0.0001) and this method performed better than other techniques.
Conclusions: An electrogram‐based optimization method accurately predicts the optimal AVD among patients over a wide range of QRS intervals during CRT in both AS and AP modes. This simple technique may obviate the need for echocardiography for AVD programming.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/j.1540-8167.2007.00770.x</identifier><identifier>PMID: 17313533</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Aged ; Aged, 80 and over ; atrial pacing ; AV delay optimization ; Bundle-Branch Block - complications ; Bundle-Branch Block - diagnosis ; Bundle-Branch Block - therapy ; Cardiac Pacing, Artificial - methods ; cardiac resynchronization therapy ; Diagnosis, Computer-Assisted - methods ; Electrocardiography - methods ; Female ; heart failure ; hemodynamics ; Humans ; In Vitro Techniques ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Therapy, Computer-Assisted - methods ; Treatment Outcome ; Ventricular Dysfunction, Left - diagnosis ; Ventricular Dysfunction, Left - etiology ; Ventricular Dysfunction, Left - therapy</subject><ispartof>Journal of cardiovascular electrophysiology, 2007-05, Vol.18 (5), p.490-496</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4700-57e3dde7fdd82e9c867ec909d3535ff6fb9abacf8ab6980eda4d6984f0caf78b3</citedby><cites>FETCH-LOGICAL-c4700-57e3dde7fdd82e9c867ec909d3535ff6fb9abacf8ab6980eda4d6984f0caf78b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1540-8167.2007.00770.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1540-8167.2007.00770.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17313533$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GOLD, MICHAEL R.</creatorcontrib><creatorcontrib>NIAZI, IMRAN</creatorcontrib><creatorcontrib>GIUDICI, MICHAEL</creatorcontrib><creatorcontrib>LEMAN, ROBERT B.</creatorcontrib><creatorcontrib>STURDIVANT, J. LACY</creatorcontrib><creatorcontrib>KIM, MICHAEL H.</creatorcontrib><creatorcontrib>YU, YINGHONG</creatorcontrib><creatorcontrib>DING, JIANG</creatorcontrib><creatorcontrib>WAGGONER, ALAN D.</creatorcontrib><title>A Prospective Comparison of AV Delay Programming Methods for Hemodynamic Optimization during Cardiac Resynchronization Therapy</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction: There are several methods for programming the optimal AV delay (AVD) during cardiac resynchronization therapy (CRT). These include Doppler echocardiographic measurements of mitral inflow or aortic outflow velocities, an arbitrarily fixed AVD, and calculations based on intracardiac electrogram (EGM) intervals. The present study was designed to compare the acute effects of AVD programming methods during CRT.
Methods and Results: We studied 28 patients at CRT implant with invasive measurements of LV dP/dt to determine the effect of AVD during atrial sensed (AS) and atrial paced (AP) modes. The optimal AVD, defined as that resulting in the maximal LV dP/dt, was then compared with that predicted by several noninvasive methods. CRT increased LV dP/dt 11%± 11% during AS (heart rate: 73 ± 14 bpm) and 17%± 12% during AP (heart rate: 86 ± 12 bpm) (P < 0.001 vs AS). There was an excellent correlation between the EGM method and the maximum achievable LV dP/dt (AS: R2= 0.99, P < 0.0001, AP: R2= 0.96, P < 0.0001) and this method performed better than other techniques.
Conclusions: An electrogram‐based optimization method accurately predicts the optimal AVD among patients over a wide range of QRS intervals during CRT in both AS and AP modes. This simple technique may obviate the need for echocardiography for AVD programming.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>atrial pacing</subject><subject>AV delay optimization</subject><subject>Bundle-Branch Block - complications</subject><subject>Bundle-Branch Block - diagnosis</subject><subject>Bundle-Branch Block - therapy</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>cardiac resynchronization therapy</subject><subject>Diagnosis, Computer-Assisted - methods</subject><subject>Electrocardiography - methods</subject><subject>Female</subject><subject>heart failure</subject><subject>hemodynamics</subject><subject>Humans</subject><subject>In Vitro Techniques</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Therapy, Computer-Assisted - methods</subject><subject>Treatment Outcome</subject><subject>Ventricular Dysfunction, Left - diagnosis</subject><subject>Ventricular Dysfunction, Left - etiology</subject><subject>Ventricular Dysfunction, Left - therapy</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkEFv0zAYhiMEYmPwF5BP3BKcOokTiUvJto5pY9O0laPl2J9XlzjO7HRrduC349Ayrliy_Ep-3s_yE0UoxUka1ud1kuYZjsu0oMkMY5qETXGyfRUdvly8DhlneUxKSg6id96vMU5JgfO30UFKSUpyQg6jX3N07azvQQz6EVBtTc-d9rZDVqH5Eh1Dy8cJuXfcGN3do0sYVlZ6pKxDZ2CsHDtutEBX_aCNfuaDDmW5cRNbcyc1F-gG_NiJlbPdX-B2BY734_vojeKthw_78yi6Oz25rc_ii6vFt3p-EYuMYhznFIiUQJWU5QwqURYURIUrGT6RK1WopuINF6rkTVGVGCTPZAiZwoIrWjbkKPq0m9s7-7ABPzCjvYC25R3YjWcUZzNCZySA5Q4UwYp3oFjvtOFuZClmk3u2ZpNiNilmk3v2xz3bhurH_RubxoD8V9zLDsCXHfCkWxj_ezA7r09CCPV4V9d-gO1LnbufrKCE5uzH9wW7PM2-Xi-WS3ZOfgMBL6VC</recordid><startdate>200705</startdate><enddate>200705</enddate><creator>GOLD, MICHAEL R.</creator><creator>NIAZI, IMRAN</creator><creator>GIUDICI, MICHAEL</creator><creator>LEMAN, ROBERT B.</creator><creator>STURDIVANT, J. LACY</creator><creator>KIM, MICHAEL H.</creator><creator>YU, YINGHONG</creator><creator>DING, JIANG</creator><creator>WAGGONER, ALAN D.</creator><general>Blackwell Publishing Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200705</creationdate><title>A Prospective Comparison of AV Delay Programming Methods for Hemodynamic Optimization during Cardiac Resynchronization Therapy</title><author>GOLD, MICHAEL R. ; NIAZI, IMRAN ; GIUDICI, MICHAEL ; LEMAN, ROBERT B. ; STURDIVANT, J. LACY ; KIM, MICHAEL H. ; YU, YINGHONG ; DING, JIANG ; WAGGONER, ALAN D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4700-57e3dde7fdd82e9c867ec909d3535ff6fb9abacf8ab6980eda4d6984f0caf78b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>atrial pacing</topic><topic>AV delay optimization</topic><topic>Bundle-Branch Block - complications</topic><topic>Bundle-Branch Block - diagnosis</topic><topic>Bundle-Branch Block - therapy</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>cardiac resynchronization therapy</topic><topic>Diagnosis, Computer-Assisted - methods</topic><topic>Electrocardiography - methods</topic><topic>Female</topic><topic>heart failure</topic><topic>hemodynamics</topic><topic>Humans</topic><topic>In Vitro Techniques</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Therapy, Computer-Assisted - methods</topic><topic>Treatment Outcome</topic><topic>Ventricular Dysfunction, Left - diagnosis</topic><topic>Ventricular Dysfunction, Left - etiology</topic><topic>Ventricular Dysfunction, Left - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>GOLD, MICHAEL R.</creatorcontrib><creatorcontrib>NIAZI, IMRAN</creatorcontrib><creatorcontrib>GIUDICI, MICHAEL</creatorcontrib><creatorcontrib>LEMAN, ROBERT B.</creatorcontrib><creatorcontrib>STURDIVANT, J. LACY</creatorcontrib><creatorcontrib>KIM, MICHAEL H.</creatorcontrib><creatorcontrib>YU, YINGHONG</creatorcontrib><creatorcontrib>DING, JIANG</creatorcontrib><creatorcontrib>WAGGONER, ALAN D.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>GOLD, MICHAEL R.</au><au>NIAZI, IMRAN</au><au>GIUDICI, MICHAEL</au><au>LEMAN, ROBERT B.</au><au>STURDIVANT, J. LACY</au><au>KIM, MICHAEL H.</au><au>YU, YINGHONG</au><au>DING, JIANG</au><au>WAGGONER, ALAN D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Prospective Comparison of AV Delay Programming Methods for Hemodynamic Optimization during Cardiac Resynchronization Therapy</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2007-05</date><risdate>2007</risdate><volume>18</volume><issue>5</issue><spage>490</spage><epage>496</epage><pages>490-496</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction: There are several methods for programming the optimal AV delay (AVD) during cardiac resynchronization therapy (CRT). These include Doppler echocardiographic measurements of mitral inflow or aortic outflow velocities, an arbitrarily fixed AVD, and calculations based on intracardiac electrogram (EGM) intervals. The present study was designed to compare the acute effects of AVD programming methods during CRT.
Methods and Results: We studied 28 patients at CRT implant with invasive measurements of LV dP/dt to determine the effect of AVD during atrial sensed (AS) and atrial paced (AP) modes. The optimal AVD, defined as that resulting in the maximal LV dP/dt, was then compared with that predicted by several noninvasive methods. CRT increased LV dP/dt 11%± 11% during AS (heart rate: 73 ± 14 bpm) and 17%± 12% during AP (heart rate: 86 ± 12 bpm) (P < 0.001 vs AS). There was an excellent correlation between the EGM method and the maximum achievable LV dP/dt (AS: R2= 0.99, P < 0.0001, AP: R2= 0.96, P < 0.0001) and this method performed better than other techniques.
Conclusions: An electrogram‐based optimization method accurately predicts the optimal AVD among patients over a wide range of QRS intervals during CRT in both AS and AP modes. This simple technique may obviate the need for echocardiography for AVD programming.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>17313533</pmid><doi>10.1111/j.1540-8167.2007.00770.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over atrial pacing AV delay optimization Bundle-Branch Block - complications Bundle-Branch Block - diagnosis Bundle-Branch Block - therapy Cardiac Pacing, Artificial - methods cardiac resynchronization therapy Diagnosis, Computer-Assisted - methods Electrocardiography - methods Female heart failure hemodynamics Humans In Vitro Techniques Male Middle Aged Prospective Studies Reproducibility of Results Sensitivity and Specificity Therapy, Computer-Assisted - methods Treatment Outcome Ventricular Dysfunction, Left - diagnosis Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - therapy |
| title | A Prospective Comparison of AV Delay Programming Methods for Hemodynamic Optimization during Cardiac Resynchronization Therapy |
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