Comparison between IEGM-based approach and echocardiography in AV/PV and VV delay optimization in CRT-D recipients (Quicksept study)

Abstract

BackgroundAtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum.MethodsAV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up.ResultsFifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively.ConclusionsIEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location.

The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

“…The Quicksept study showed that aortic velocity time integral (aVTI) values at the optimized AV and VV intervals as determined by echocardiography and by the QuickOpt algorithm were quite well correlated and that this correlation was maintained in long-term follow-up [ 5 , 59 ]. AV and VV delay optimization data were collected in 13 centres using both echocardiographic and QuickOpt guidance in CRT-D implanted patients provided with this algorithm [ 5 ].…”

“…Speckle tracking echocardiography (STE) has been reported as a useful imaging method to detect CRT responders [ 3 , 4 ]. Atrioventricular (AV) and interventricular (VV) delay optimization can augment ventricular function in CRT and is usually performed utilizing echocardiography [ 5 ]. The conflicting evidence can be attributed to a combination of factors including poor precision, lack of experience, short follow-up time, late responders, or failure to distinguish non-responders.…”

Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

“…In this study, two MPP configurations guided by QuickOpt™ were shown to provide the most improvement with PEP compared to a fixed VV delay of 5 ms or 15 ms. However, as with other device‐based CRT optimization tools, QuickOpt™ has not been shown to be superior to echo optimization methods or improve hard clinical outcomes …”

“…However, as with other device-based CRT optimization tools, QuickOpt TM has not been shown to be superior to echo optimization methods or improve hard clinical outcomes. 13,17,18…”

Manual Intracardiac Electrogram Method Is Accurate Alternative to Echocardiography for Atrioventricular and Interventricular Optimization in Cardiac Resynchronization Therapy

“…Our study is the fi rst to show that manual IEGM can be used for VV optimization after CRT implantation, even for devices that do not have automated IEGM system. Previous studies have shown that IEGM is an accurate alternative to time-consuming echocardiography techniques for VV optimization 14,18,[23][24][25] . St Jude's CRT devices have automated IEGM systems, which can accurately calculate AV and VV delay in one minute.…”