Optimization of Cardiac Resynchronization Therapy

Bhan, Amit; Kapetanakis, Stamatis; Monaghan, Mark

doi:10.1111/j.1540-8175.2008.00789.x

Cited by 20 publications

(21 citation statements)

References 61 publications

(64 reference statements)

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“…The greatest aortic velocity time integral and the lowest interventricular mechanical delay (IVMD) were obtained with 30 ms LV pre-excitation. The resting AVD was optimized to provide the longest transmitral filling time without A wave truncation from pulsed wave Doppler analysis of the LV filling [2]. The optimal AVD during atrial-sensed rhythm (70-72 bpm) was 30 ms, which was the shortest AVD available in the device (Figure 1).…”

Section: Case Reportmentioning

confidence: 99%

“…The response to CRT depends on several factors, including device settings. Optimally programmed atrio-ventricular delay (AVD) can affect the acute haemodynamic response and may influence the magnitude of clinical improvement under chronic pacing [2]. There are scarce data regarding the AVD optimization in CRT patients during atrial-paced compared with atrial-sensed biventricular pacing.…”

Section: Introductionmentioning

confidence: 99%

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Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

Dąbrowska−Kugacka

Lewicka²,

Faran³

et al. 2011

aoms

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The present case report describes a patient with an artificial mitral valve and dual chamber pacemaker implanted due to perioperative complete atrio-ventricular block. One year later an upgrade to cardiac resynchronization therapy (CRT) combined with ICD function was performed due to significant progression of heart failure symptoms. Beneficial effects of CRT are demonstrated, but unfavourable haemodynamic consequences of right atrial appendage pacing are also underlined. Important interatrial conduction delay during atrial paced rhythm resulted in a significant time difference between optimal sensed and paced atrio-ventricular delay (AVD). This report provides a practical outline how to determine the interatrial delay and the sensed-paced AVD offset under echocardiography in patients treated with CRT.

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Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

Dąbrowska−Kugacka

Lewicka²,

Faran³

et al. 2011

aoms

View full text Add to dashboard Cite

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“…Echocardiographic techniques for optimization of both AV and VV delays have been comprehensively described in recent review papers [27, 93, 94]. In general, echocardiography is a widely available and non-invasive technique without significant burden for the patient.…”

Section: Methods For Optimization Of Av and Vv Delaysmentioning

confidence: 99%

Atrioventricular and interventricular delay optimization in cardiac resynchronization therapy: physiological principles and overview of available methods

2010

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In this review, the physiological rationale for atrioventricular and interventricular delay optimization of cardiac resynchronization therapy is discussed including the influence of exercise and long-term cardiac resynchronization therapy. The broad spectrum of both invasive and non-invasive optimization methods is reviewed with critical appraisal of the literature. Although the spectrum of both invasive and non-invasive optimization methods is broad, no single method can be recommend for standard practice as large-scale studies using hard endpoints are lacking. Current efforts mainly investigate optimization during resting conditions; however, there is a need to develop automated algorithms to implement dynamic optimization in order to adapt to physiological alterations during exercise and after anatomical remodeling.

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“…The AV delay may be optimized with Doppler echocardiography by evaluating the aortic velocity time integral (AoVTI), which serves as a surrogate for LV stroke volume [18], [27], [28]. Three dimensional echocardiography (3DE) is an accurate and reproducible method to quantify LV dyssynchrony [29].…”

Section: Introductionmentioning

confidence: 99%

Acute Beneficial Hemodynamic Effects of a Novel 3D-Echocardiographic Optimization Protocol in Cardiac Resynchronization Therapy

et al. 2012

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BackgroundPost-implantation therapies to optimize cardiac resynchronization therapy (CRT) focus on adjustments of the atrio-ventricular (AV) delay and ventricular-to-ventricular (VV) interval. However, there is little consensus on how to achieve best resynchronization with these parameters. The aim of this study was to examine a novel combination of doppler echocardiography (DE) and three-dimensional echocardiography (3DE) for individualized optimization of device based AV delays and VV intervals compared to empiric programming.Methods25 recipients of CRT (male: 56%, mean age: 67 years) were included in this study. Ejection fraction (EF), the primary outcome parameter, and left ventricular (LV) dimensions were evaluated by 3DE before CRT (baseline), after AV delay optimization while pacing the ventricles simultaneously (empiric VV interval programming) and after individualized VV interval optimization. For AV delay optimization aortic velocity time integral (AoVTI) was examined in eight different AV delays, and the AV delay with the highest AoVTI was programmed. For individualized VV interval optimization 3DE full-volume datasets of the left ventricle were obtained and analyzed to derive a systolic dyssynchrony index (SDI), calculated from the dispersion of time to minimal regional volume for all 16 LV segments. Consecutively, SDI was evaluated in six different VV intervals (including LV or right ventricular preactivation), and the VV interval with the lowest SDI was programmed (individualized optimization).ResultsEF increased from baseline 23±7% to 30±8 (p<0.001) after AV delay optimization and to 32±8% (p<0.05) after individualized optimization with an associated decrease of end-systolic volume from a baseline of 138±60 ml to 115±42 ml (p<0.001). Moreover, individualized optimization significantly reduced SDI from a baseline of 14.3±5.5% to 6.1±2.6% (p<0.001).ConclusionsCompared with empiric programming of biventricular pacemakers, individualized echocardiographic optimization with the integration of 3-dimensional indices into the optimization protocol acutely improved LV systolic function and decreased ESV and can be used to select the optimal AV delay and VV interval in CRT.

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Optimization of Cardiac Resynchronization Therapy

Cited by 20 publications

References 61 publications

Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

Atrioventricular and interventricular delay optimization in cardiac resynchronization therapy: physiological principles and overview of available methods

Acute Beneficial Hemodynamic Effects of a Novel 3D-Echocardiographic Optimization Protocol in Cardiac Resynchronization Therapy

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