Interatrial Conduction Measured During Biventricular Pacemaker Implantation Accurately Predicts Optimal Paced Atrioventricular Intervals

Levin, Vadim; Nemeth, Margit A.; Colombowala, Ilyas; Massumi, Ali; Rasekh, Abdi; Cheng, Jie; Coles, James A.; Ujhelyi, Michael R.; Razavi, Mehdi

doi:10.1111/j.1540-8167.2006.00744.x

Cited by 16 publications

(17 citation statements)

References 23 publications

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“…In line with earlier findings in DDD and CRT pacing, we showed a positive correlation between the length of the IACD and length of optimal AV delay 16,17 . Lengthening of the AV delay lengthens atrial refractory periods and lowers the 2:1 point, which could theoretically interfere with exercise tolerance.…”

Section: Other Outcome Measuressupporting

confidence: 78%

Clinical benefit of atrio-ventricular delay optimization in patients with a dual-chamber pacemaker: a pilot study. The CBRAVO trial (NCT01998256)

et al. 2016

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Objective Outcome data on exercise capacity following atrio-ventricular (AV) optimization of dual-chamber pacing are sparse. Pacemaker settings are often left at manufacturers' nominal values upon implantation. We studied the short-term effect of AV optimization on exercise capacity in patients with a dual-chamber pacemaker. Methods and resultsTwenty-eight patients (mean age 73 ± 14 y) with a dual-chamber pacemaker, were randomized towards either nominal AV settings (group 1) or echo-guided AV optimization using the iterative mitral inflow VTI (velocity time integral) method (group 2) at baseline. At 4 weeks, patients were crossed-over to AV optimization in group 1 and returned to nominal AV settings in group 2 for another period of 4 weeks.Oxygen uptake efficiency slope improved significantly after AV optimization (by 126.7 mL/logL ± 190.7 mL/logL; P = 0.003).Conclusions AV optimization in dual-chamber pacing significantly improved functional capacity after 4 weeks. These data provide the background for further validation studies. Keywords AV optimization -interatrial conduction delay -interatrial mechanical delay -dual-chamber pacemaker.contraction of the left atrium can compromise left ventricular filling, leading to an early increase in atrial filling pressures and a limitation in functional exercise capacity 2 . Oxygen uptake efficiency slope (OUES) is a validated marker of exercise capacity in healthy subjects and in patients with heart failure 3 .Resolution of left AV asynchrony in DDD pacing can be obtained by AV delay optimization and has been shown to improve acute haemodynamics in patients with an important IACD 4,5 . Several validated methods for AV optimization exist 6 . However, data on the effects of this intervention on short-and long-term clinical end points as exercise capacity, morbidity and mortality, are sparse.The aim of this pilot study was to investigate the short-term effect of AV optimization on functional [ Original article ]

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Section: Other Outcome Measuressupporting

confidence: 78%

Clinical benefit of atrio-ventricular delay optimization in patients with a dual-chamber pacemaker: a pilot study. The CBRAVO trial (NCT01998256)

et al. 2016

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“…To achieve resynchronization in the setting of baseline dyssynchrony, the LV must be paced before or simultaneously with intrinsic AV conduction [12]. This requires that the AV delay on the device must be programmed shorter than the native PR interval.…”

Section: Discussionmentioning

confidence: 99%

Impact of baseline PR interval on cardiac resynchronization therapy outcomes in patients with narrow QRS complexes: an analysis of the ReThinQ Trial

Joshi

Stopper

et al. 2015

J Interv Card Electrophysiol

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“…Furthermore, because AV-nodal conduction time lengthens at higher heart rates, this also will increase the AVCP during atrial pacing. Described methods for estimating AVCP have relied on invasive monitoring of left atrial electrical activity using a sensing electrode placed in the coronary sinus 31,32 or in the esophagus. 33,34 Intervals to left atrial sensing after right atrial pacing and after an intrinsic right atrial depolarization are measured, and the difference between the 2 intervals is used to define interatrial conduction delay.…”

Section: Discussionmentioning

confidence: 99%

“…The nominal pace-sense offset correction for AVCP is 30 ms for most implantable BiVP devices. 31 Assumed values can markedly underestimate the true AVCP. 26,27,30,33 In the present analysis, AVCP ranged from 28 to 100 ms, with an average of 64.…”

Section: Discussionmentioning

confidence: 99%

Effect of Atrioventricular Conduction Prolongation on Optimization of Paced Atrioventricular Delay for Biventricular Pacing After Cardiac Surgery

Rusanov

Wang

Cabreriza

et al. 2012

Journal of Cardiothoracic and Vascular Anesthesia

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Objectives Atrioventricular conduction prolongation (AVCP) in cardiac pacing is measurable and results primarily from delayed atrial conduction. Noninvasive methods for measuring atrial conduction are lacking. Accordingly, AVCP was used to estimate atrial conduction and investigate its role on the paced atrioventricular delay (pAVD) during biventricular pacing (BiVP) optimization. Design Retrospective analysis of data collected as part of a randomized controlled study of temporary BiVP after cardiopulmonary bypass. Setting Single-center study at university-affiliated tertiary care hospital. Participants Cardiac surgical patients at risk of left ventricular failure after cardiopulmonary bypass. Interventions Temporary BiVP was optimized immediately after cardiopulmonary bypass. Vasoactive medication and fluid infusion rates were held constant during optimization. Measurements and Main Results For each patient the AVCP and the pAVD producing the optimum (highest) cardiac output (OptCO) and mean arterial pressure (OptMAP) were determined. Patients were stratified into long- and short-AVCP groups. Overall AVCP (mean ± standard deviation) was 64 ± 28 ms. For the short-AVCP group (<64 ms, n = 3), AVCP, OptCO, and OptMAP were 40 ± 11, 120 ± 0, and 150 ± 30 ms, respectively, and for the long-AVCP group (>64 ms, n = 4), these same parameters were 89 ± 10, 218 ± 44, and 218 ± 29 ms. OptCO and OptMAP were significantly less in the short-AVCP group (p = 0.015 and p = 0.029, respectively). Conclusions AVCP varies widely after cardiopulmonary bypass, affecting optimum pAVD. Failure to correct for this can result in the selection of inappropriately short and potentially deleterious pAVDs, especially when nominal pAVD is used, causing BiVP to appear ineffective.

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Interatrial Conduction Measured During Biventricular Pacemaker Implantation Accurately Predicts Optimal Paced Atrioventricular Intervals

Abstract: The paced IACT has a strong correlation with the echo derived optimal PAV. This method may be used to program PAV intervals without need for echocardiography in patients undergoing BiV pacemaker implantation.

Cited by 16 publications

References 23 publications

Clinical benefit of atrio-ventricular delay optimization in patients with a dual-chamber pacemaker: a pilot study. The CBRAVO trial (NCT01998256)

Clinical benefit of atrio-ventricular delay optimization in patients with a dual-chamber pacemaker: a pilot study. The CBRAVO trial (NCT01998256)

Impact of baseline PR interval on cardiac resynchronization therapy outcomes in patients with narrow QRS complexes: an analysis of the ReThinQ Trial

Effect of Atrioventricular Conduction Prolongation on Optimization of Paced Atrioventricular Delay for Biventricular Pacing After Cardiac Surgery

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