TY - JOUR
T1 - Atrioventricular optimization in cardiac resynchronization therapy with quadripolar leads
T2 - should we optimize every pacing configuration including multi-point pacing?
AU - van Everdingen, Wouter M.
AU - Zweerink, Alwin
AU - Salden, Odette A. E.
AU - Cramer, Maarten J.
AU - Doevendans, Pieter A.
AU - van Rossum, Albert C.
AU - Prinzen, Frits W.
AU - Vernooy, Kevin
AU - Allaart, Cornelis P.
AU - Meine, Mathias
N1 - Funding Information:
Conflict of interest: M.M. has received research grants from Boston Scientific and St. Jude Medical. K.V. has received speaker fees and research grants from St. Jude Medical. F.W.P. has received research grants from Medtronic Inc., Boston Scientific Corp., St. Jude Medical, LivaNova, Biosense Webster, and EBR Systems and is advisor to Medtronic Inc. All the remaining authors declare that they have no conflict of interests.
Funding Information:
This study was conducted with an unrestricted research grant from St. Jude Medical (St. Paul, MN, USA).
Publisher Copyright:
© The Author(s) 2018.
PY - 2019/1
Y1 - 2019/1
N2 - Aims This study aims to define an atrioventricular (AV) delay optimization method for cardiac resynchronization therapy (CRT) with a quadripolar left ventricular (LV) lead based on intrinsic conduction intervals.Methods and results Heart failure patients with a left bundle branch block underwent CRT implantation with a quadripolar LV lead. Invasive LV pressure-volume loops were recorded during four biventricular and three multi-point pacing (MPP) settings, using four patient-specific paced AV delays. Haemodynamic response was defined as change in stroke work (A%SW) compared to intrinsic rhythm and was related to the following conduction intervals: right atrial pacing to right ventricular sensing interval (RAp-RVs), Q to LV sensing interval normalized to QRS duration (QLV/QRSd), PR-interval, and P-wave duration. In 44 patients, the largest Delta%SW (104 +/- 76%) occurred at a paced AV delay of 128 +/- 32 ms, at 47 +/- 9% of RAp-RVs. Optimal AV delay of biventricular pacing (126 +/- 26 ms) did not differ from MPP (126 +/- 21 ms, P = 0.29). Intra-class correlation coefficient between optimal AV delays of different pacing configurations was 0.64 (0.45-0.78, P <0.001). Although not statistically significant, Delta%SW at 50% of RAp-RVs (98 +/- 74%) was closer to the maximal achievable Delta%SW increase than a fixed interval of 120ms (96 +/- 73%, P = 0.60). RAp-RVs, QLV/QRSd, PR interval, and P-wave duration were associated with the optimal AV delay in univariate analysis, but only RAp-RVs remained significantly associated in multivariate analysis (R = 0.69).Conclusion The AV delay that provides highest haemodynamic response is similar for various LV pacing configurations and for MPP. An AV delay similar to 50% of RAp-RVs creates an acute haemodynamic response close to the maximal patient-specific response.
AB - Aims This study aims to define an atrioventricular (AV) delay optimization method for cardiac resynchronization therapy (CRT) with a quadripolar left ventricular (LV) lead based on intrinsic conduction intervals.Methods and results Heart failure patients with a left bundle branch block underwent CRT implantation with a quadripolar LV lead. Invasive LV pressure-volume loops were recorded during four biventricular and three multi-point pacing (MPP) settings, using four patient-specific paced AV delays. Haemodynamic response was defined as change in stroke work (A%SW) compared to intrinsic rhythm and was related to the following conduction intervals: right atrial pacing to right ventricular sensing interval (RAp-RVs), Q to LV sensing interval normalized to QRS duration (QLV/QRSd), PR-interval, and P-wave duration. In 44 patients, the largest Delta%SW (104 +/- 76%) occurred at a paced AV delay of 128 +/- 32 ms, at 47 +/- 9% of RAp-RVs. Optimal AV delay of biventricular pacing (126 +/- 26 ms) did not differ from MPP (126 +/- 21 ms, P = 0.29). Intra-class correlation coefficient between optimal AV delays of different pacing configurations was 0.64 (0.45-0.78, P <0.001). Although not statistically significant, Delta%SW at 50% of RAp-RVs (98 +/- 74%) was closer to the maximal achievable Delta%SW increase than a fixed interval of 120ms (96 +/- 73%, P = 0.60). RAp-RVs, QLV/QRSd, PR interval, and P-wave duration were associated with the optimal AV delay in univariate analysis, but only RAp-RVs remained significantly associated in multivariate analysis (R = 0.69).Conclusion The AV delay that provides highest haemodynamic response is similar for various LV pacing configurations and for MPP. An AV delay similar to 50% of RAp-RVs creates an acute haemodynamic response close to the maximal patient-specific response.
KW - Cardiac resynchronization therapy
KW - Atrioventricular delay
KW - Pressure-volume loops
KW - Optimization
KW - Multi-point pacing
KW - Quadripolar lead
KW - HEART-FAILURE PATIENTS
KW - BUNDLE-BRANCH BLOCK
KW - CLINICAL-RESPONSE
KW - AV DELAY
KW - INTERVALS
U2 - 10.1093/europace/euy138
DO - 10.1093/europace/euy138
M3 - Article
C2 - 30052906
SN - 1099-5129
VL - 21
SP - E11-E19
JO - EP Europace
JF - EP Europace
IS - 1
ER -