Heart sound–derived systolic time intervals for atrioventricular delay optimization in cardiac resynchronization therapy

Luo, Hongxing; Westphal, Philip; Shahmohammadi, Mehrdad; Heckman, Luuk I.B.; Kuiper, Marion; Cornelussen, Richard; Delhaas, Tammo; Prinzen, Frits W.

doi:10.1016/j.hrthm.2022.12.031

Cited by 1 publication

(1 citation statement)

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“…Echocardiography techniques include those that focus on mitral inflow (the Ritter method, the most commonly used iterative method, and the “fast- and simple” approach) or on the aortic pulsed-wave Doppler velocity time integral. Alternative techniques to optimize AV delay consist of impedance cardiography, finger photoplethysmography, hemodynamic optimization using noninvasive blood pressure measurements, acoustic cardiography, or peak endocardial acceleration [ 24 , 25 , 26 ]. Moreover, a flow pattern in the LV outflow tract in which there is coupling between mitral-aortic flow reversal and ejection flow has also been described as a way for determining optimal AV delay [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy beyond Nominal Settings: An IEGM-Based Approach for Paced and Sensed Atrioventricular Delay Offset Optimization in Daily Clinical Practice

Kloosterman

Daniëls

Roseboom

et al. 2023

JCM

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Optimization of the atrioventricular (AV) delay has been performed in several landmark trials in cardiac resynchronization therapy (CRT), although it is often not performed in daily practice. Our aim was to study optimal AV delays and investigate a simple intracardiac electrogram (IEGM)-based optimization approach. 328 CRT patients with paired IEGM and echocardiography optimization data were included in our single-center observational study. Sensed (sAV) and paced (pAV) AV delays were optimized using an iterative echocardiography method. The offset between sAV and pAV delays was calculated using the IEGM method. The mean age of the patients was 69 ± 12 years; 64% were men, 48% had ischemic etiology of heart failure. During echocardiographic optimization, an offset of 73 ± 18 ms was found, differing from nominal AV settings (p < 0.001). Based on the IEGM method, the optimal offset was 75 ± 25 ms. The echocardiographic and IEGM-generated AV offset delays showed good correlation (R2 = 0.62, p < 0.001) and good agreement according to Bland-Altman plot analysis. CRT responders had a near zero offset difference between IEGM and echo optimization (−0.2 ± 17 ms), while non-responders had an offset difference of 6 ± 17 ms, p = 0.006. In conclusion, optimal AV delays are patient-specific and differ from nominal settings. pAV delay can easily be calculated from IEGM after sAV delay optimization.

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