Echocardiographic AV-interval optimization in patients with reduced left ventricular function

Abstract

Background: Ritter's method is a tool used to optimize AV delay in DDD pacemaker patients with normal left ventricular function only. The goal of our study was to evaluate Ritter's method in AV delay-interval optimization in patients with reduced left ventricular function.

Cardiac Resynchronization Therapy Optimization by Ultrasonic Cardiac Output Monitoring (USCOM) Device

“…Despite the fact that Ritter's method is not measuring the cardiac output or its derivatives, it was designed to ensure maximal left ventricular filling in the shortest diastolic interval and then by the Frank Starling law, maximizing the cardiac output. This is well proven that the optimal AVI obtained from Ritter's method correlates well with standard radionuclide ventriculography 5 . It is effective for optimization AV intervals particularly with poor left ventricular function (EF < 35%) 5 …”

“…This is well proven that the optimal AVI obtained from Ritter's method correlates well with standard radionuclide ventriculography. 5 It is effective for optimization AV intervals particularly with poor left ventricular function (EF < 35%). 5…”

“…Atrio‐ventricular interval (AVI) is critical to optimize hemodynamic in patients with CRT. The determination of optimal AVI can be performed noninvasively with Doppler echocardiography of the mitral valve inflow in which the AVI is adjusted for optimal left ventricular filling and hence maximizing cardiac output (Ritter's method) 4–6 . Another established non‐invasive method for optimal AVI determination is by the cardiac output estimation with pulse Doppler echocardiography at the left ventricular outflow tract (LVOT) 7,8 .…”

“…The determination of optimal AVI can be performed noninvasively with Doppler echocardiography of the mitral valve inflow in which the AVI is adjusted for optimal left ventricular filling and hence maximizing cardiac output (Ritter's method). [4][5][6] Another established noninvasive method for optimal AVI determination is by the cardiac output estimation with pulse Doppler echocardiography at the left ventricular outflow tract (LVOT). 7,8 However, these methods can be time-consuming and expensive, especially if repeated AVI optimization is needed.…”

Optimization of atrio-ventricular delay in patients with dual-chamber pacemaker

“…The echocardiographic methods of AVD optimization have a well established role, however they are not free of certain limitations namely time burden [19] and indispensable presence of an experienced echocardiographist and the cost.…”