Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography

Elien B. Engels; Bernard Thibault; Jan Mangual; Nima Badie; Luke C. McSpadden; Leonardo Calo; Philippe Ritter; Carlo Pappone; Kerstin Bode; Niraj Varma; Frits W. Prinzen

doi:10.1016/j.jelectrocard.2019.09.026

Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography

Elien B. Engels, Bernard Thibault, Jan Mangual, Nima Badie, Luke C. McSpadden, Leonardo Calo, Philippe Ritter, Carlo Pappone, Kerstin Bode, Niraj Varma, Frits W. Prinzen^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Optimal timing of the atrioventricular delay in cardiac resynchronization therapy (CRT) can improve synchrony in patients suffering from heart failure. The purpose of this study was to evaluate the impact of SyncAV (TM) on electrical synchrony as measured by vectorcardiography (VCG) derived QRS metrics during biventricular (BiV) pacing.

Methods: Patients implanted with a cardiac resynchronization therapy (CRT) device and quadripolar left ventricular (LV) lead underwent 12-lead ECG recordings. VCG metrics, including QRS duration (QRSd) and area, were derived from the ECG by a blinded observer during: intrinsic conduction, BiV with nominal atrioventricular delays (BiV Nominal), and BiV with SyncAV programmed to the optimal offset achieving maximal synchronization (BiV + SyncAV Opt).

Results: One hundred patients (71% male, 40% ischemic, 65% LBBB, 32 +/- 9% ejection fraction) completed VCG assessment. QRSd during intrinsic conduction (166 +/- 25 ms) was narrowed successively by BiV Nominal (137 +/- 23 ms, p <.05 vs. intrinsic) and BiV + SyncAV Opt (122 +/- 22 ms, p

Conclusion: With VCG-based, patient-specific optimization of the programmable offset, SyncAV reduced electrical dyssynchrony beyond conventional CRT. Crown Copyright (C) 2019 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Original language	English
Pages (from-to)	1-6
Number of pages	6
Journal	Journal of Electrocardiology
Volume	58
DOIs	https://doi.org/10.1016/j.jelectrocard.2019.09.026
Publication status	Published - 2020

Keywords

Cardiac resynchronization therapy
Vectorcardiography
Electrical optimization
CARDIAC-RESYNCHRONIZATION THERAPY
OPTIMIZATION
AREA
PART

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10.1016/j.jelectrocard.2019.09.026Licence: CC BY-NC-ND

Cite this

Engels, E. B., Thibault, B., Mangual, J., Badie, N., McSpadden, L. C., Calo, L., Ritter, P., Pappone, C., Bode, K., Varma, N., & Prinzen, F. W. (2020). Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography. Journal of Electrocardiology, 58, 1-6. https://doi.org/10.1016/j.jelectrocard.2019.09.026

@article{b83c99aba8c6465eaf0cd2cf14afb90c,

title = "Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography",

abstract = "Background: Optimal timing of the atrioventricular delay in cardiac resynchronization therapy (CRT) can improve synchrony in patients suffering from heart failure. The purpose of this study was to evaluate the impact of SyncAV (TM) on electrical synchrony as measured by vectorcardiography (VCG) derived QRS metrics during biventricular (BiV) pacing.Methods: Patients implanted with a cardiac resynchronization therapy (CRT) device and quadripolar left ventricular (LV) lead underwent 12-lead ECG recordings. VCG metrics, including QRS duration (QRSd) and area, were derived from the ECG by a blinded observer during: intrinsic conduction, BiV with nominal atrioventricular delays (BiV Nominal), and BiV with SyncAV programmed to the optimal offset achieving maximal synchronization (BiV + SyncAV Opt).Results: One hundred patients (71% male, 40% ischemic, 65% LBBB, 32 +/- 9% ejection fraction) completed VCG assessment. QRSd during intrinsic conduction (166 +/- 25 ms) was narrowed successively by BiV Nominal (137 +/- 23 ms, p <.05 vs. intrinsic) and BiV + SyncAV Opt (122 +/- 22 ms, pConclusion: With VCG-based, patient-specific optimization of the programmable offset, SyncAV reduced electrical dyssynchrony beyond conventional CRT. Crown Copyright (C) 2019 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).",

keywords = "Cardiac resynchronization therapy, Vectorcardiography, Electrical optimization, CARDIAC-RESYNCHRONIZATION THERAPY, OPTIMIZATION, AREA, PART",

author = "Engels, {Elien B.} and Bernard Thibault and Jan Mangual and Nima Badie and McSpadden, {Luke C.} and Leonardo Calo and Philippe Ritter and Carlo Pappone and Kerstin Bode and Niraj Varma and Prinzen, {Frits W.}",

note = "Funding Information: JM, NB and LM are employees of Abbott. FP, CP, BT and LC received research grants and/or are consultants with Abbott. NV reports consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, and Medtronic. This study was funded by Abbott. Funding Information: EE received a post-doctoral research fellowship from the Cardiac Arrhythmia Network of Canada (CANet). JM, NB and LM are employees of Abbott. FP, CP, BT and LC received research grants and/or are consultants with Abbott. NV reports consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, and Medtronic. This study was funded by Abbott. Funding Information: EE received a post-doctoral research fellowship from the Cardiac Arrhythmia Network of Canada (CANet). JM, NB and LM are employees of Abbott. FP, CP, BT and LC received research grants and/or are consultants with Abbott. NV reports consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, and Medtronic. This study was funded by Abbott . Publisher Copyright: {\textcopyright} 2018",

year = "2020",

doi = "10.1016/j.jelectrocard.2019.09.026",

language = "English",

volume = "58",

pages = "1--6",

journal = "Journal of Electrocardiology",

issn = "0022-0736",

publisher = "Churchill Livingstone Inc Medical Publishers",

}

TY - JOUR

T1 - Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography

AU - Engels, Elien B.

AU - Thibault, Bernard

AU - Mangual, Jan

AU - Badie, Nima

AU - McSpadden, Luke C.

AU - Calo, Leonardo

AU - Ritter, Philippe

AU - Pappone, Carlo

AU - Bode, Kerstin

AU - Varma, Niraj

AU - Prinzen, Frits W.

N1 - Funding Information: JM, NB and LM are employees of Abbott. FP, CP, BT and LC received research grants and/or are consultants with Abbott. NV reports consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, and Medtronic. This study was funded by Abbott. Funding Information: EE received a post-doctoral research fellowship from the Cardiac Arrhythmia Network of Canada (CANet). JM, NB and LM are employees of Abbott. FP, CP, BT and LC received research grants and/or are consultants with Abbott. NV reports consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, and Medtronic. This study was funded by Abbott. Funding Information: EE received a post-doctoral research fellowship from the Cardiac Arrhythmia Network of Canada (CANet). JM, NB and LM are employees of Abbott. FP, CP, BT and LC received research grants and/or are consultants with Abbott. NV reports consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, and Medtronic. This study was funded by Abbott . Publisher Copyright: © 2018

PY - 2020

Y1 - 2020

N2 - Background: Optimal timing of the atrioventricular delay in cardiac resynchronization therapy (CRT) can improve synchrony in patients suffering from heart failure. The purpose of this study was to evaluate the impact of SyncAV (TM) on electrical synchrony as measured by vectorcardiography (VCG) derived QRS metrics during biventricular (BiV) pacing.Methods: Patients implanted with a cardiac resynchronization therapy (CRT) device and quadripolar left ventricular (LV) lead underwent 12-lead ECG recordings. VCG metrics, including QRS duration (QRSd) and area, were derived from the ECG by a blinded observer during: intrinsic conduction, BiV with nominal atrioventricular delays (BiV Nominal), and BiV with SyncAV programmed to the optimal offset achieving maximal synchronization (BiV + SyncAV Opt).Results: One hundred patients (71% male, 40% ischemic, 65% LBBB, 32 +/- 9% ejection fraction) completed VCG assessment. QRSd during intrinsic conduction (166 +/- 25 ms) was narrowed successively by BiV Nominal (137 +/- 23 ms, p <.05 vs. intrinsic) and BiV + SyncAV Opt (122 +/- 22 ms, pConclusion: With VCG-based, patient-specific optimization of the programmable offset, SyncAV reduced electrical dyssynchrony beyond conventional CRT. Crown Copyright (C) 2019 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

AB - Background: Optimal timing of the atrioventricular delay in cardiac resynchronization therapy (CRT) can improve synchrony in patients suffering from heart failure. The purpose of this study was to evaluate the impact of SyncAV (TM) on electrical synchrony as measured by vectorcardiography (VCG) derived QRS metrics during biventricular (BiV) pacing.Methods: Patients implanted with a cardiac resynchronization therapy (CRT) device and quadripolar left ventricular (LV) lead underwent 12-lead ECG recordings. VCG metrics, including QRS duration (QRSd) and area, were derived from the ECG by a blinded observer during: intrinsic conduction, BiV with nominal atrioventricular delays (BiV Nominal), and BiV with SyncAV programmed to the optimal offset achieving maximal synchronization (BiV + SyncAV Opt).Results: One hundred patients (71% male, 40% ischemic, 65% LBBB, 32 +/- 9% ejection fraction) completed VCG assessment. QRSd during intrinsic conduction (166 +/- 25 ms) was narrowed successively by BiV Nominal (137 +/- 23 ms, p <.05 vs. intrinsic) and BiV + SyncAV Opt (122 +/- 22 ms, pConclusion: With VCG-based, patient-specific optimization of the programmable offset, SyncAV reduced electrical dyssynchrony beyond conventional CRT. Crown Copyright (C) 2019 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

KW - Cardiac resynchronization therapy

KW - Vectorcardiography

KW - Electrical optimization

KW - CARDIAC-RESYNCHRONIZATION THERAPY

KW - OPTIMIZATION

KW - AREA

KW - PART

U2 - 10.1016/j.jelectrocard.2019.09.026

DO - 10.1016/j.jelectrocard.2019.09.026

M3 - Article

C2 - 31677533

SN - 0022-0736

VL - 58

SP - 1

EP - 6

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

ER -