Prediction of Interatrial and Interventricular Electromechanical Delays from P/QRS Measurements: Value for Pacemaker Timing Optimization

Chirife, Raúl; Pastori, Julio D.; Mosto, Hugo; Arrascaite, Monica; Sambelashvili, Aleksandre

doi:10.1111/j.1540-8159.2007.00966.x

Cited by 15 publications

(14 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this study, the optimal AV delay was determined by identifying the AV interval with the narrowest QRS width in the BiV + intrinsic pacing group, which was performed by ECG but not echocardiography. Chirife, et al 21) showed that inter-atrial and inter-ventricular electromechanical delays can be determined by P-wave and QRS durations, indicating that AV delay optimization in CRT could be predicted by ECG with no need for echocardiography, which supported our study findings.…”

Section: Discussionsupporting

confidence: 90%

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Guo

Zhang

et al. 2015

Int. Heart J.

View full text Add to dashboard Cite

SummaryWe sought to evaluate the impact of biventricular (BiV) pacing with ventricular fusion by intrinsic atrioventricular nodal (AVN) conduction (BiV + intrinsic pacing) on clinical outcomes in patients with chronic heart failure (CHF) receiving cardiac resynchronization therapy (CRT).A total of 44 patients were randomized to receive either BiV or BiV + intrinsic pacing for one month. Echocardiographic optimization was performed for the BiV pacing mode, while the BiV + intrinsic pacing mode was achieved by titrating AV delay under electrocardiography (ECG) monitoring. Symptoms, quality of life, ECG, echocardiography, and cardiovascular events were recorded at baseline and the end of the follow-up for each pacing mode.Patients undergoing BiV + intrinsic pacing mode had shorter QRS duration compared to those with conventional BiV pacing (118.4 ± 21.6 ms versus 146.4 ± 5.3 ms, P < 0.0001). Also, these patients had improved echocardiographic left ventricular fractional shortening (LVFS) (17.4 ± 5.9 versus 15.7 ± 4.9, P = 0.019), higher left ventricular ejection fraction (LVEF) (35.5 ± 9.7 versus 32.7 ± 9.7, P = 0.048), longer 6-minute walk test (6MWT) (372.5 ± 80.9 m versus 328.7 ± 108.9 m, P = 0.0001), and better Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (12.5 ± 6.6 versus 18.2 ± 12.3, P = 0.0001).Treating CHF patients with BiV+intrinsic pacing resulted in improved cardiac function and quality of life. BiV + intrinsic pacing can be used in CHF patients with sinus rhythm and normal AV nodal conduction to improve CRT efficacy. (Int Heart J 2015; 56: 293-297) Key words: Intrinsic conduction, Heart failure, Electrocardiography, Echocardiography C ongestive heart failure (CHF) is a major public health problem associated with high mortality and morbidity. 1) Common causes of CHF include, but are not limited to ischemic heart disease, hypertension, arrhythmias, valvular diseases, cardiomyopathies, and congenital heart diseases.2,3) Cardiac resynchronization therapy (CRT), also known as biventricular pacing (BiV) or multisite ventricular pacing, simultaneously paces the right ventricle and the left ventricle. Large randomized clinical trials have shown that CRT improves symptoms, cardiac functions, and survival in patients with heart failure who have electrical dyssynchrony. CRT has been recommended by the American Heart Association (AHA) guidelines for patients with recurrent symptoms of systolic heart failure and a wide QRS complex, despite being on optimal medical therapy. [4][5][6][7][8] CRT allows for more efficient blood ejection by reducing mechanical inefficiency from dyssynchronous contraction. 3,9,10) However, there is a wide spectrum of clinical responses to CRT and one third of the patients who are selected for CRT fail to demonstrate any benefit from it.11,12) Therefore, the current clinical focus in CRT is to maximize the benefit from this therapy.A physiological approach to pacing is important for patients with CHF. It can be achieved by a number of methods including CRT, rate ada...

show abstract

Section: Discussionsupporting

confidence: 90%

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Guo

Zhang

et al. 2015

Int. Heart J.

View full text Add to dashboard Cite

show abstract

“…The relation between P‐wave duration or interatrial conduction interval and optimal AV delay has been explained previously 25–27 . Optimal AV interval requires LV contraction to start soon after the completion of LA contraction.…”

Section: Discussionmentioning

confidence: 94%

Optimal Atrioventricular Delay in CRT Patients Can Be Approximated Using Surface Electrocardiography and Device Electrograms

Jones¹,

Svinarich²,

Rubin³

et al. 2010

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…A high degree of atrial pacing can compromise CRT response because of the difference in sensed and paced AV delays, and the effect on left-sided fi lling in AV resynchronization. When programming the sensed AV (SAV) and paced AV (PAV) delays, it is important to keep in mind that the PAV delay is usually longer than the SAV delay [ 16 ]. Latency in sensing and capture along with interatrial conduction delay contributes to this difference.…”

Section: Atrioventricular Optimizationmentioning

confidence: 99%

Optimization of cardiac resynchronization therapy after implantation

Hasan

Abraham²

2008

Curr Treat Options Cardiovasc Med

View full text Add to dashboard Cite

Many patients do not respond clinically to cardiac resynchronization therapy (CRT), despite clinical and survival benefits demonstrated in numerous clinical trials. This has led to focused evaluation from preimplant issues, as to who is an appropriate candidate for CRT, to postimplant issues, more specifically, optimizing device programming in CRT. CRT studies have used simultaneous biventricular pacing, but with advancing echocardiographic technology, the role of dyssynchrony, or mechanical delay in contraction of the ventricles, suggests that individually tailoring ventricular pacing improves hemodynamics. Atrial to ventricular timing affects left ventricular filling and cardiac output, whereas the right to left ventricular pacing delay also improves systolic and diastolic performance. The importance of device programming parameters and optimal pacing delays in biventricular pacing is reviewed in this article.

show abstract

Prediction of Interatrial and Interventricular Electromechanical Delays from P/QRS Measurements: Value for Pacemaker Timing Optimization

Abstract: Inter-atrial and inter-ventricular electromechanical delays can be predicted from P-wave and QRS durations. These measurements allow AV delay optimization in DDD and cardiac resynchronization therapy devices with no need of Doppler echocardiography.

Cited by 15 publications

References 11 publications

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Biventricular Pacing With Ventricular Fusion by Intrinsic Activation in Cardiac Resynchronization Therapy

Optimal Atrioventricular Delay in CRT Patients Can Be Approximated Using Surface Electrocardiography and Device Electrograms

Optimization of cardiac resynchronization therapy after implantation

Contact Info

Product

Resources

About