Discordant electrical and mechanical atrial delays affect intracavitary electrogram-based cardiac resynchronization therapy optimization

Porciani, Maria Cristina; Ricceri, Ilaria; Attanà, Paola; Pennesi, Matteo; Michelotti, Federica; Mascia, Giuseppe; Sacchi, Stefano; Hashtroudi, Lawrence; Padeletti, Luigi

doi:10.1093/europace/eur335

Cited by 7 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This algorithm is currently being evaluated in the FREEDOM study, 153 but preliminary results show no clear benefits so far. Two small studies have shown no improved prediction of optimal interventricular delay with this algorithm co mpared with using an interventricular delay of 0 ms. 154,155 The SmartAV algorithm, assessed in the SmartDelay study, 100 also uses lead electrograms and QRS duration to predict atrioventricular and interventricular delay. Neither the SmartAV algorithm nor echocardiographic optimization showed any benefit over the use of a default atrioventricular delay of 120 ms. 100 The AdaptiveCRT algorithm 144 uses lead electrograms to calculate the atrioventricular delay to optimize fusion of the LV-pacing-derived wavefront with that from intrinsic conduction, at least if the atrio-RV delay is ≤200 ms and heart rate is <100 bpm.…”

Section: Importance Of the Percentage Of Pacingmentioning

confidence: 99%

Strategies to improve cardiac resynchronization therapy

et al. 2014

View full text Add to dashboard Cite

Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.

show abstract

Section: Importance Of the Percentage Of Pacingmentioning

confidence: 99%

Strategies to improve cardiac resynchronization therapy

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Current automatic algorithms for AV delay optimization cannot measure IACT as they are based on RA, RV, and LV IEGMs. Thus, in case of interatrial delays these algorithms might fail to identify the best AV interval as they lack information on timing of LA activation 12 …”

Section: Discussionmentioning

confidence: 99%

Interatrial conduction time from electrograms of cardiac resynchronization therapy devices with left ventricular sensing

Marinaccio

Giacopelli

Resta

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background: The interatrial conduction time (IACT) is relevant for atrioventricular delay optimization in cardiac resynchronization therapy (CRT) devices. However, this information cannot be easily used as it requires invasive measurements. We tested whether electrical activation of left atrium (LA) could be detected in CRT devices with left ventricular (LV) sensing and used to estimate IACT. Methods: The presence of LA activation on LV channel was evaluated in consecutive patients implanted with CRT and quadripolar LV leads whose sensing was temporarily set in the most proximal polarity (Ring LV4-housing). Estimates of IACT during sinus rhythm and atrial pacing were measured and compared with the values obtained with invasive catheterization of coronary sinus. Results: Among six patients (50% female; mean age 73.3 ± 4.9 years) included in the analysis, four (66%) had a visible LA signal on the LV channel. The mean IACT measured with device electrograms was 71 ± 8 ms and 133 ± 15 ms during sinus rhythm and atrial pacing, respectively. These values were equivalent to the measurements obtained during invasive catheterization. Both patients without evidence of LA activation had an LV lead with a short total interelectrodes distance (46 mm) resulting in a significant anatomical distance between Ring LV4 and LA. Conclusions: In CRT devices with left ventricular sensing, LA signal could be detected and used to estimate IACT especially if long-spaced electrodes are used.

show abstract

“…Their lack of benefit may be due to the rest condition and to the low frequency of the AV and VV intervals optimization. Moreover, Porciani et al have shown that automatic algorithms such as QuickOpt may fail to identify the best AV and VV intervals, since in patients with severe heart failure the electrical activation times do not always coincide with the times of mechanical activation [33]. While previous automatic algorithms did not demonstrate any beneficial effect, the automatic PEA method, based on the mechanical acceleration of the heart has been shown to be closely consistent with the cardiac ultrasound in the timings of aortic and mitral valve closures and in the estimation of systolic and diastolic intervals durations [29].…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Sensor in Cardiac Implantable Electric Devices: The Endocardial Accelaration Technology

Sacchi

Contardi

Pieragnoli

et al. 2000

Journal of Healthcare Engineering

View full text Add to dashboard Cite

There have been substantial progresses in the technology of cardiac implantable electric devices (CIEDs) during the past decades. One of the progresses is represented by the development of a hemodynamic sensor embedded at the tip of a pacing lead that measures myocardial contractility by the analysis of myocardial mechanical vibrations occurring during the cardiac cycle. This sensor, providing continuous hemodynamic monitoring, could play an important role in clinical practice because of several clinical applications in CIEDs recipients. The objectives of this work are to report how this sensor operates and to review the main findings about its clinical applications.

show abstract

Discordant electrical and mechanical atrial delays affect intracavitary electrogram-based cardiac resynchronization therapy optimization

Abstract: Our results show that MIAD plays the main role in determining the optimal AV delay, thus caution should be taken when optimizing AV by IEGM-based methods.

Cited by 7 publications

References 17 publications

Strategies to improve cardiac resynchronization therapy

Strategies to improve cardiac resynchronization therapy

Interatrial conduction time from electrograms of cardiac resynchronization therapy devices with left ventricular sensing

Hemodynamic Sensor in Cardiac Implantable Electric Devices: The Endocardial Accelaration Technology

Contact Info

Product

Resources

About