Acute Evaluation of Programmer-Guided AV/PV and VV Delay Optimization Comparing an IEGM Method and Echocardiogram for Cardiac Resynchronization Therapy in Heart Failure Patients and Dual-Chamber ICD Implants

Introduction: Intracardiac delay optimization of biventricular and dual‐chamber pacing devices currently relies on time‐consuming echocardiographic measurements. A novel intracardiac electrogram (IEGM) method for atrioventricular (AV/PV) and interventricular (VV) delay optimization was developed, which can be performed during routine device follow‐up. Methods and Results: In this prospective, nonrandomized, multi‐center trial, patients previously implanted with St. Jude Medical cardiac resynchronization therapy defibrillator (CRT‐D) devices or dual‐chamber implantable cardioverter defibrillators (ICDs) underwent standard AV/PV and/or VV delay optimization guided by Doppler echocardiogram measurements of the maximum aortic velocity time integral (aortic VTI). Aortic VTI measurements applying the IEGM method recommended delays were then obtained in all patients. Fifty‐eight patients (age: 68 ± 11 years; 81% male; 74% ischemic) and 57 patients (age: 71 ± 10 years; 74% male; 71% ischemic) were enrolled for AV/PV and VV delay evaluation, respectively. An independent core lab determined the maximum aortic VTIs. Data analysis of the AV, PV, and VV delays demonstrated the concordance correlation coefficient (CCC) between the standard method aortic VTI values and the IEGM method aortic VTI values was 97.5%, 96.1%, and 96.6%, respectively. All analyses demonstrated that the CCC > 90% (P < 0.05). Conclusion: The automated programmer‐based IEGM method provides a reliable and simpler alternative to standard techniques for the optimization of AV/PV and VV delay settings in patients with CRT‐D devices and dual‐chamber ICDs.