What Range of Programmable AV Delays is Necessary in Antibradycardia DDD Stimulation?

Abstract

DDD pacemakers differ considerably in device specific extents of AV delay (AVD) programmability. To demonstrate the requirements of a mean DDD pacemaker patient population optimal AVDs in 200 DDD pacemaker patients (age 8 to 91 years) were estimated by left atrial electrography. The results should help to define an AVD programmability standard. Left atrial electrograms were recorded via a bipolar filtered esophageal lead. The method aims on adjusting the left atrial electrogram to 70 ms prior to the ventricular spike, both during VDD and DDD operation of the pacemaker. In atrial sensed stimulation the optimal AVD varied from 40 to 205 ms (100.5 +/- 24.5 ms) and in atrial paced stimulation from 85 to 245 ms (169.1 +/- 24.5 ms). The difference of the mean values is statistically significant (p < 0.001). The difference between both values in the individual patient, the individual AVD correction time, varied from 0 to 170 ms (68.7 +/- 26.6 ms). Thus, from our findings requirements on AV delay programmability standard can be derived: AVDs (1) should have a range from 40 to 250 ms, (2) should be independently programmable during atrial sensed and atrial paced operation, and (3) should provide as nominal settings 100 ms for atrial sensed and 170 ms for atrial paced stimulation.

Impact of Fusion Avoidance on Performance of the Automatic Threshold Tracking Feature in Dual Chamber Pacemakers: A Multicenter Prospective Randomized Study

“…Autocapture: On PV delay: 120 ms, AV delay: 190 ms (in agreement with suggestions from the literature) 8,9 Negative AV/PV Hysteresis Search: Off Rest Rate: Off Rate Adaptive PV delay: Off AICS: randomized to On or Off according to the randomization list. Other parameters: up to the investigators.…”

Pacemaker Therapy in a Pediatric Patient with Hypertrophic Obstructive Cardiomyopathy and Rapid Intrinsic Atrioventricular Conduction

“…Next, constant AP with an AV delay of 70 msec was programmed and complete preexcitation achieved. In healthy adults, AP and AS have the same hemodynamic effect when the difference in the corresponding AV delays is about 30 msec [4,7]. Concerning the electromechanical effect, in our patient AP was superior to AS when the difference in the AV delays was 30 msec.…”

Echocardiographic AV-interval optimization in patients with reduced left ventricular function

“…Kindermann [10] considers AV opt = 88 ms ± 35 ms with atrial triggering, and AV opt = 143 ms ± 41 ms for the AV sequential mode. Knorre [18] has determined AV opt = 100.5 ± 27.8 ms for atrial triggering, and AV opt = 169 ± 24.5 ms for the AV sequential mode. Haskel [5] has established the best AV interval to be 150 ms. Janosik [6] considers AV opt = 144 ± 48 ms with atrial triggering, and AV opt = 176 ± 44 ms for the AV sequential mode.…”

“…Leman et al [16] have demonstrated that it is also possible to utilize measurement of left ventricular ejection fraction and stroke volume by myocardial thallium scintigraphy as a means of AV interval optimization. A further possibility involves detection of left atrial depolarization by an esophageal electrode recording [17,18]. During recent years, the use of Doppler echocardiography in conjunction with the mitral valve inflow profile has been investigated as means of AV interval optimization: i.e., Ritter's method [19].…”