Should we use the rate-adaptive AV delay in cardiac resynchronization therapy-pacing?

Melzer, Christoph; Bondke, Hansjürgen; Körber, Thomas; Nienaber, Christoph; Baumann, Gert; Ismer, B.

doi:10.1093/europace/eum257

Cited by 29 publications

(30 citation statements)

References 23 publications

(29 reference statements)

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“…Although Scharf et al 25 suggested an increase in AVD during exercise, more recent publications argue against the need for changing the AVD during exercise. 26,27 It is possible that AVD auto-calibration using integrated haemodynamic sensors with the capability of repeated testing will be helpful to identify device settings that account for the varying conditions during daily life.…”

Section: Body Positionsmentioning

confidence: 99%

Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

et al. 2009

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AimsThe aim of this study was to study the haemodynamic effect of atrioventricular delay (AVD) modifications within a narrow range in different body positions and during exercise in patients receiving cardiac resynchronization therapy (CRT). MethodsThe previously optimized AVD was shortened and prolonged by 40 ms in 27 CRT patients and 9 controls without heart failure. Cardiac output (CO) was measured by inert gas rebreathing (Innocor) as the average over different body positions (left-lateral, supine, sitting, standing, and exercise). In eight CRT patients with an implantable haemodynamic monitor, the estimated pulmonary artery diastolic pressure (ePAD) was analysed. ResultsThe magnitude of CO response to AVD changes was greater in CRT patients than in controls (0.25 vs. 0.20 L/min, P , 0.05), varied substantially between individuals (range: 0.12-0.56 L/min), and correlated with left atrial size (r ¼ 0.61, P , 0.001). On average, AVD shortening decreased CO slightly (0.07 + 0.17 L/min) and increased ePAD (1.1 + 0.8 mmHg, both P , 0.05), whereas prolongation had no significant effect. ConclusionThe haemodynamic response to AVD modifications within a narrow range is larger in CRT patients than in normal controls and varies substantially between individuals. These findings suggest that optimal AVD tuning is clinically important in selected patients.--

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Section: Body Positionsmentioning

confidence: 99%

Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

et al. 2009

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“…Abbreviations as in Figures 1, 4, and 6. known about the magnitude of AVD shortening with increased heart rate in heart failure patients and whether AVD should be shortened, kept constant (47,48), or prolonged (49) as heart rate increases. Recent studies suggest that AVD changes during exercise are variable (50).…”

Section: Naqvi Echocardiography In Pacemaker Optimizationmentioning

confidence: 99%

Echocardiography-Guided Biventricular Pacemaker Optimization

Naqvi

2010

JACC: Cardiovascular Imaging

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Optimization of atrioventricular delay (AVD) and interventricular delay (VVD) in patients with a biventricular (Biv) pacemaker has been associated with improvement in cardiac output acutely, a reduction in heart failure symptoms, and improved exercise capacity. Several individual echocardiography (echo) Doppler parameters have been used for pacemaker optimization. In this review, pacemaker optimization based on echocardiographic evaluation of cardiac hemodynamics is presented. The goals of this paper are to discuss studies in echo-guided pacemaker optimization, provide a systemic guide to pacemaker interrogation and optimization in patients after Biv pacing who may have complex hemodynamic derangement, and finally, to discuss studies in optimization with exercise or atrial pacing. Case examples highlighting hemodynamic derangement in heart failure, tailoring of Biv pacemaker optimization to the underlying physiologic derangement, and its improvement with optimization are presented. (J Am Coll Cardiol Img 2010;3: 1168 -80)

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“…3 Whether adaptive AVDs provide an additional benefit over (echocardiographically optimized) fixed AVDs has not been finally clarified; respective studies have produced conflicting results. [4][5][6] Usually, echocardiographic AVD optimization is performed shortly after device implantation in order to identify the "optimal" AVD. However, respective measurements are performed at rest, and it remains unclear whether this also ensures optimized exercise hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

“…However, previous studies in CRT patients have produced conflicting results. [4][5][6] This prospective monocenter study was designed to compare fixed with adaptive AVD programming in CRT devices with respect to exercise hemodynamics using a noninvasive hemodynamic monitor.…”

Section: Introductionmentioning

confidence: 99%

Atrioventricular delay programming in cardiac resynchronization therapy devices: fixed or adaptive?

Schueler

Voss

Bauer

et al. 2012

Journal of Electrocardiology

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Should we use the rate-adaptive AV delay in cardiac resynchronization therapy-pacing?

Abstract: In consideration of the findings of the studies performed to date, the rate-adaptive AV delay should be deactivated.

Cited by 29 publications

References 23 publications

Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

Echocardiography-Guided Biventricular Pacemaker Optimization

Atrioventricular delay programming in cardiac resynchronization therapy devices: fixed or adaptive?

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