Rate-adaptive AV delay and exercise performance following cardiac resynchronization therapy

Shanmugam, Nesan; Prada-Delgado, Óscar; Campos, A. García; Grimster, Alex; Valencia, Oswaldo; Baltabaeva, Aigul; Jones, S.; Anderson, Lisa

doi:10.1016/j.hrthm.2012.07.001

Cited by 22 publications

(17 citation statements)

References 26 publications

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“…In the present study, we found that the direction of change of intrinsic ARV intervals as heart rate increased was variable from patient to patient with relatively small overall changes. This is consistent with other studies in the literature showing the optimal AV delay during exercise increased, decreased, or did not change in patients with CRT. This is, in contrast, to exercise in patients receiving pacemakers or those with channelopathies in whom AV intervals consistently shorten .…”

Section: Discussionsupporting

confidence: 93%

The effect of posture, exercise, and atrial pacing on atrioventricular conduction in systolic heart failure

Niu

Sturdivant

et al. 2019

Cardiovasc electrophysiol

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Background Optimization of atrioventricular (AV) intervals for cardiac resynchronization therapy (CRT) programming is typically performed in supine patients at rest, which may not reflect AV timing in other conditions. Objective To evaluate the effects of posture, exercise, and atrial pacing on intrinsic AV intervals in patients with CRT devices. Methods Rate‐dependent A‐V delay by exercise was a multicenter, prospective trial of patients in sinus rhythm following CRT implantation. Intracardiac electrograms were recorded to analyze atrial to right ventricular (ARV), atrial to left ventricular (ALV), and RV to LV (VV) time intervals. Heart rate was increased with incremental atrial pacing in different postures, followed by an exercise treadmill test. Results This study included 36 patients. At rest, AV intervals changed minimally with posture. With atrial pacing, AV interval immediately increased compared with sinus rhythm, with ARV slopes being 8.1 ± 7.7, 8.8 ± 13.4, and 6.8 ± 6.5 milliseconds per beat per minute (ms/bpm) and ALV slopes being 8.2 ± 7.7, 9.1 ± 12.8, and 7.0 ± 6.5 ms/bpm for supine, standing and sitting positions, respectively. As the paced heart rate increased, ARV and ALV intervals increased more gradually with similar trends. Interventricular conduction times changed less than 0.2 ms/bpm with atrial pacing. During exercise, the direction of change of intrinsic ARV intervals, as heart rate increased, was variable between patients with relatively small overall group changes (0.1 ± 1.4 and 0.2 ± 1.2 ms/bpm for ARV and ALV, respectively). Conclusion Posture and exercise have a smaller effect on AV timing compared with atrial pacing. However, individualized optimization and dynamic rate related changes may be needed to maintain optimal fusion with left ventricular (LV) stimulation.

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Section: Discussionsupporting

confidence: 93%

The effect of posture, exercise, and atrial pacing on atrioventricular conduction in systolic heart failure

Niu

Sturdivant

et al. 2019

Cardiovasc electrophysiol

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“…However programming rate responsive AV delay ON was encouraged in the MIRACLE trials [5]. A recent pilot study by Shanmugam [21] showed that programming rate adaptive AV delay ON improves exercise capacity and advised to revise the debate regarding rate adaptive AV delay.…”

Section: Discussionmentioning

confidence: 99%

Optimisation of cardiac resynchronization therapy in clinical practice during exercise

et al. 2013

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AimsAlthough cardiac resynchronisation therapy (CRT) is an established treatment to improve cardiac function, a significant amount of patients do not experience noticeable improvement in their cardiac function. Optimal timing of the delay between atrial and ventricular pacing pulses (AV delay) is of major importance for effective CRT treatment and this optimum may differ between resting and exercise conditions. In this study the feasibility of haemodynamic measurements by the non-invasive finger plethysmographic method (Nexfin) was used to optimise the AV delay during exercise.Methods and resultsThirty-one patients implanted with a CRT device in the last 4 years participated in the study. During rest and in exercise, stroke volume (SV) was measured using the Nexfin device for several AV delays. The optimal AV delay at rest and in exercise was determined using the least squares estimates (LSE) method. Optimisation created a clinically significant improvement in SV of 10 %. The relation between HR and the optimal AV delay was patient dependent.ConclusionA potential increase in SV of 10 % can be achieved using Nexfin for optimisation of AV delay during exercise. A considerable number of patients showed benefit with lengthening of the AV delay during exercise.

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“…18 Accordingly, the significance of AV synchrony for maximizing cardiac performance is well described and is more pronounced in patients with systolic HF. 5,8,10,11 To date, several studies have shown that AV and VV optimization improves LV systolic performance even during exercise. 8,10,11 We demonstrated that the optimal AV delay progressively shortened during exercise, and similar findings have been reported by Sun et al, 8 who showed an almost 40% reduction in the programmed AV delay during exercise.…”

Section: Effects Of Optimization Performed During Exercisementioning

confidence: 99%

Novel Device-Based Algorithm Provides Optimal Hemodynamics During Exercise in Patients With Cardiac Resynchronization Therapy

Kasagawa

Nakajima

Izumo

et al. 2019

Circ J

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Background: An adaptive cardiac resynchronization therapy (aCRT) algorithm has been described for synchronized left ventricular (LV) pacing and continuous optimization of cardiac resynchronization therapy (CRT). However, there are few algorithmic data on the effect of changes during exercise. Methods and Results: We enrolled 27 patients with availability of the aCRT algorithm. Eligible patients were manually programmed to optimal atrioventricular (AV) and interventricular (VV) delays by using echocardiograms at rest or during 2 stages of supine bicycle exercise. We compared the maximum cardiac output between manual echo-optimization and aCRT-on during each phase. After initiating exercise, the optimal AV delay progressively shortened (P<0.05) with incremental exercise levels. The manual-optimized settings and aCRT resulted in similar cardiac performance, as demonstrated by a high concordance correlation coefficient between the LV outflow tract velocity time integral (LVOT-VTI) during each exercise stage (Ex.1: r=0.94 P<0.0008, Ex.2: r=0.88 P<0.001, respectively). Synchronized LV-only pacing in patients with normal AV conduction could provide a higher LVOT-VTI as compared with manual-optimized conventional biventricular pacing at peak exercise (P<0.05). Conclusions: The aCRT algorithm was physiologically sound during exercise by patients.

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Rate-adaptive AV delay and exercise performance following cardiac resynchronization therapy

Abstract: Background: Physiological shortening of the atrioventricular (AV) interval with

Cited by 22 publications

References 26 publications

The effect of posture, exercise, and atrial pacing on atrioventricular conduction in systolic heart failure

The effect of posture, exercise, and atrial pacing on atrioventricular conduction in systolic heart failure

Optimisation of cardiac resynchronization therapy in clinical practice during exercise

Novel Device-Based Algorithm Provides Optimal Hemodynamics During Exercise in Patients With Cardiac Resynchronization Therapy

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